Study By Logistic Regression Combined With MDR On The Independent Influence Factors And Interactions Of MACCE During 6 Months Following PCI

The technology of PCI has been improved prominently,it still has not been as satisfactory as we holp,with a major adverse cardiovascular and cerebrovascular events(MACCE)incidence of>10%.As a result,it is significant to perfect the influence factor system of MACCE following PCI,Which can help us identify the high risk groups and make optimal clinical decision.Through learning papers,we noticed that influence factors of MACCE following PCI is complicated.TCM provides us with a new perspective as for perfecting the system hopefully.Chinese oral patent drugs have been widely used in clinical practice for a long time.But it's therapeutic effect is lack of confirmation by large sample randomized controlled trials.What' s more,it is the developing trend that paying attention to the independent influence factors and interactions as well.Study one:Meta analysis of complementary treatment of Chinese oral patent drugs influencing MACCE during 6 months or more following PCI.Objective To systematically review the efficacy of routine Western medicine(RWM)plus Chinese oral patent drugs for MACCE during 6 months or more following PCI.Methods Electronic databases,such as PubMed,The Cochrane Library,EMBase,Clinicaltrials.gov,Biosis Preview,CNKI,VIP,CBM,Wanfang and other relevant databases,were searched for randomized control trials that compared Chinese oral patent drugs plus RWM with the same RWM(or plus placebo)in preventing MACCE during 6 months or more following PCI.The quality of retrieved literature was assessed by methods from Cochrane Handbook.Valid data were extracted and analyzed by meta-analysis using RevMan5.3 and STATA 12.0 software.Results A total of 27 trials(4661 patients)met the inclision criteria and were analyzed.Meta-analysis showed that at at least 6 months' follow-up,Chinese oral patent drugs plus RWM could significantly reduce primary endpoint(RR=0.52,95%CI[0.30?0.90],P=0.02),cardiac mortality(RR=0.40,95%CI[0.19?0.82],P=0.01),acute myocardial infarction(RR=0.39,95%CI[0.24-0.61],P<0.0001),numbers of repeat revascularization(RR=0.45,95%CI[0.33?0.62],P<0.00001),Stroke(RR=0.52,95%CI[0.30?0.90],P=0.02),readmission for ACS(RR=0.60,95%CI[0.47?0.77],P<0.001),hear failure(RR=0.27,95%CI[0.13?0.54],P=0.0002).Methodological quality of included trials were generally poor.Conclusions Chinese oral patent drugs may help prevent MACCE during at least 6 months following PCI.Caution should be exercised in drawing a definitive conclusion due to the poor methodological quality.Study two:Study by logistic regression combined with MDR on the independent influence factors and interactions of MACCE during 6 months following PCI.Objective To identify the independent influence factors and interactions of MACCE during 6 months following PCI.Methods Adopting the nested case control study to investigate 2900 patients with CHD who undergone PCI,among them we selected 55 patients who encounterd MACCE during 6 months following PCI as the case group and the other as the control group.The data of patients from the retrospective study was gone on statistical analysis by using logistic regression combined with MDR.Results1)The incidence of MACCE during 6 months following PCI was 1.9%.2)As for primary endpoint during 6 months following PCI:multicariate logistic regression analysis indicated 4 independent influence factors:TC(OR=1.89,95%CI[1.29?2.78]),statin(OR=0.21,95%CI[0.06?0.91]),dyslipidemia(OR=6.12,95%CI[1.62?18.92]),stroke(OR=4.31,95%CI[1.37?11.52]);MDR showed the optimal model containing TC,HDL-C,BMI and systolic pressure,among which TC and BMI had strong synergistic action.3)With regard to secondary endpoint during 6 months following PCI:multicariate logistic regression analysis indicated 5 independent influence factors:age(OR=1.92,95%CI[1.14?3.16]),drinking(OR=3.61,95%CI[1.46?8.91]),blood stasis score(OR=2.71,95%CI[1.10?6.01]),stroke(OR=3.33,95%CI[1.28?7.70]),left main lesion(OR=5.58,95%CI[1.24?17.95]);MDR showed the optimal model containing eGFR,HDL-C,age,diastolic pressure,stent length(>2.8 cm),stent diameter(>3.0 cm),blood stasis and Qi stagnation syndrome and number of stents.Blood stasis and Qi stagnation syndrome and number of stents had strong synergistic action.Conclusions1)It is practical to use logistic regression combined with MDR identifying influence factors.2)As for primary endpoint during 6 months following PCI:TC,statin,dyslipidemia and stroke were independent influence factors.Specifically speaking,with the increace of TC level,the risk of primary endpoint would also rise.The history of dyslipidemia and stroke would be risky,while statin can prevent primary endpoint.Patienst with low-level of HDL-C,obesity,high cholesterol and elevated systolic blood pressure were high-risk,in particular the one with high level of BMI and TC.With considerations of both the results of MDR and logistic regression,we thought the pivotal influence factor of primary endpoint following PCI lies in serum lipid.So the control of blood lipid is vital.3)With regard to secondary endpoint during 6 months following PCI:age,drinking,blood stasis score,stroke,left main lesion were independent influence factors.It means with the climb up of age and the degree of blood stasis,the risk of primary endpoint would also raise.Drinking,stroke and left main lesion would be risky.The elderly with lots long and thin stents,who belong to blood stasis and Qi stagnation syndrome,if they fail to control their diastolic pressure,HDL-C and renal function,are risky for secondary endpoint.The elderly with lots stents already deserves high focus.With considerations of both the results of MDR and logistic regression,we thought the pivotal influence factors of secondary endpoint following PCI are age and blood stasis.It indicates the vital pathogenesis lies in blood stasis.4)In conclusion,we come up with that the vital treatment of preventing MACCE is controling blood lipid as well as complementary treatment of activating.blood circulation.In addition,patients with history of stroke should be paid more attention.