| Research background:In the country,the number of patients with senile coronary heart disease is increasing,especially those with acute coronary syndrome or stable angina.More and more elderly patients are taking PCI treatment.Currently,the risk stratification and recognition for high risk patients as well as individual intervention treatment measures are the main concerns in the perioperative period of coronary interventional treatment.Some foreign developed countries have established several risk scoring systems for coronary interventional treatment,however,these systems are not aimed at elderly patients;in Guidelines for Percutaneous Coronary Intervention in China 2012,the recommended common risk scoring models are not all aimed at patients with senile coronary heart disease;the applicability of these systems in treating coronary heart disease in elderly patients in China remains unknown.To further explore the risk assessment of PCI in treating senile coronary heart disease,through the retrospection,collection and arrangement of past case data,the department of cardiology in Changhai Hospital preliminarily established a risk scoring model which is easy to use to evaluate and predict the occurrence probability of adverse cardiac events in elderly patients over 75 years old after the PCI.However,for the fact that the risk assessment is a retrospective study on past case date,further verification and improvement are still needed.Therefore,by the prospective analysis of the features of the underlying disease and the lesion of coronary artery in patients with senile coronary heart disease,as well as the occurrence of probability of adverse cardiac events,an adaptive risk assessing system for patients with senile coronary heart disease in China can be searched.Purpose:To further verify the established risk assessment model for predicting the adverse cardiac events in elderly patients with coronary heart disease after PCI operation.To investigate the predictive value of the occurrence probability of MACCE during hospitalization,1 month,3 months and 6 months after the operation.Method:There were 344 consecutive elderly patients(age?75)who have been diagnosed as coronary heart disease and taken PCI treatment in our hospital from January 2015 to September 2015 selected,followed up after the operation for half a year.The clinical data of these patients were completely collect,arranged and statistically analyzed.Survival analysis was conducted by Kaplan—Meier method,univariate and multivariate analysis were performed by Cox proportional hazard model,and the area under curve of ROC analysis was used to compare three methods.After applying risk factors of all patients to PCI risk scoring model for elderly patients with coronary heart disease,the predictive ability of the model to predict the MACCE during hospitalization and the fitting correction performance were verified;this risk scoring model is compared with risk scoring systems of NCDRCathPCI and SYNTAX.Three scoring systems were evaluated to predict the clinical prognosis of the elderly patients with coronary heart disease after PCI in China.Results:1.In the study,344 cases were followed up.There were 29 adverse cardiac events intotal(8.43%),17 deaths(4.94%),2 recurrent myocardial infarctions(0.58%)and 4cerebrovascular accidents(1.16%).2.To further verify the established risk assessment model for predicting the adverse cardiac events in elderly patients with coronary heart disease after PCI operation during hospitalization,the result suggests that the risk assessment model of postoperative in-hospital MACCE incidence has good prediction and fitting performance(under the ROC curve area of 0.747,P = 0.001;Hosmer lemeshow goodness of fit test X2=1.75,P = 0.972).The predictive performance of the model is good for the incidence of MACCE after 1 months,(AUC=0.704,95% CI 0.584~0.824,P=0.005)and the prediction performance of MACCE is poor in the 3 months and half year after operation(AUC=0.594?0.590,P>0.05).3.Survival analysis showed that the incidence of MACCE was gradually increased in three groups of patients with low risk,medium risk and high risk by the PCI risk score of elderly patients with coronary heart disease.The difference between the three groups was statistically significant during hospitalization and the 1 month after operation(P<0.05);the difference was not statistically significant between the three groups in the 3 months and half year after operation(P>0.05).4.Univariate and multivariate Cox regression analysis demonstrated that the PCI risk score of elderly patients with coronary heart disease was an independent predictive factor for the rate of in-hospital MACCE in patients after operation(HR 1.560,95% CI 1.253~1.944,P<0.001),was an independent predictive factor for the rate of 1 month MACCE in patients after operation(HR 1.408,95% CI 1.034~1.919,P=0.030),was an independent predictive factor for the rate of 3 months after operation(HR 1.447,95% CI 1.171~1.789,P=0.001),and was an independent predictive factor for the rate of half year after operation(HR 1.360,95% CI 1.113~1.662,P=0.003)?5.Analysis of the area under the ROC curve showed that NCDRCathPCI risk scoring system and Syntax scoring system did poor in prediction performance of MACCE occurrence probability during hospitalization,1 month,3 months and 6 months after the operation(P>0.05).Conclusion:1.The elderly coronary heart disease patients undergoing PCI risk score is an independent predictive factor of MACCE in elderly coronary heart disease patients after PCI.The PCI risk scoring model has a good prediction and fitting performance of the occurrence probability of MACCE during hospitalization,and it has a good prediction performance for the incidence of MACCE in the 1 month after operation.However,the model has a certain degree of limitation,poor in prediction performance of MACCE occurrence probability 3 months and 6 months after the operation.2.For elderly patients with coronary heart disease,the NCDRCathPCI risk scoring system and Syntax scoring system show poor prediction performance of MACCE occurrence probability both during hospitalization and after the operation. |
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