| ObjectivePercutaneous coronary intervention(PCI)is an important treatment method for coronary heart disease.Elderly patients are an important group of cardiovascular diseases.The elderly patients may reappear after PCI due to various confounding factors.Various clinical symptoms and even death are occur.Sometimes the condition of the coronary artery is aggravated and the coronary artery has to be revascularized again.This study retrospectively analyzed the risk factors for revascularization in elderly patients after PCI,and clarified the high risk factors for recurrence in elderly patients after PCI,and provided a certain scientific basis for preventing the recurrence of coronary artery disease after PCI.MethodA total of 165 elderly patients diagnosed with acute coronary syndrome were included in this study after screening.These patients were all under Coronary angiography twice in the Second Affiliated Hospital of Dalian Medical University from January 1,2017 to December 31,2019.The age of the first angiography is greater or equal to 65 years old and all have undergone PCI.There are 81 patients who underwent revascularization in the second coronary angiography,which is the revascularization group,which means the experimental group.The number of patients with no significant progression of coronary artery disease on second-coronary angiography was 84 cases,which were the control group.The clinical baseline data of the two groups of patients,the risk factors of cardiovascular disease,the laboratory indicators of the two operations,the conditions of the two coronary artery diseases,the results of cardiac ultrasound,medication and other results were analyzed.At the same time,according to the method of revascularization,the experimental groups are divided into: target lesion revascularization(TLR),target vessel revascularization(TVR),non-target vessel revascularization(NTVR),and mixed lesion group(MLR).SPSS 23.0 software was used for data analysis.The measurement data that obeys the normal distribution are expressed as mean ± standard deviation((?)±s),and the comparison between groups is by t test;the measurement data of skewed distribution is expressed as the median M(P25,P75),using Mann-Whitney U test compares the differences between the two groups.The enumeration data is expressed as a percentage(%),and the chi-square test is used for comparison between groups.Multivariate analysis uses multiple Logistic regression model analysis.The risk estimate is expressed by OR and 95% confidence interval.P<0.05 is a statistically significant difference.ResultCompared with the control group,the revascularization group had more diabetes history in the first hospital admission [43(54.8%)vs19(22.1%),P=0.031];the first admi ssion to the hospital had higher glycated hemoglobin.(6.87±1.82vs5.97±0.66,P=0.024);the first postoperative use of clopidogrel was more [72(88.7%)vs46(55.2),P=0.043];th e first postoperative use of ticagrelor was less [9(11.3%)vs38(44.7%),P=0.031];more a ngiotensin converting enzyme inhibitors/angiotensin receptor blockers are used [53(65.8%)vs24(28.3%),P =0.032];the first operation has more multivessel lesions [48(59.6%)vs18(20.6%),P=0.033];the total length of the first stent placement is longer;(42.34±20.76vs32.76±24.48,P=0.042);The total diameter of the first stent is larger(12.85±2.61vs8.43±2.43,P=0.035);the interval between two interventions is longer(12.8±2.3vs7.5±1.8,P=0.039);Diabetes patients admitted to the hospital are more More [45(55.6%)vs22(25.9%),P=0.031],higher systolic blood pressure(133.19±21.20vs122.38±16.64,P=0.044)after re-admission;lower HDL cholesterol(1.06)±0.48vs1.58±0.69,P=0.031);re-a dmission to hospital has higher low-density lipoprotein cholesterol(2.03±1.32vs1.82±1.01,P=0.048);re-admission to hospital is higher(0.91±0.13vs0.73±0.04,P=0.049);high er glycated hemoglobin(6.94±0.47vs6.03±0.12,P=0.039)after rehospitalization;higher troponin I(1.39±0.98vs0.17±0.98,P =0.005);creatine kinase isoenzyme MB was highe r in rehospitalization(16.12±12.03vs3.14±7.43,P 0.001);D-dimer was higher in reho spitalization(0.79±0.36vs0.38±0.21,P =0.045);fewer people were re-admitted to the L DL standard [15(18.5%)vs40(47.6%),P=0.031].Interval between two interventions(OR=1.520,95%CI 1.003～2.459,P=0.005),l ow-density lipoprotein re-admission(OR=7.668,95%CI 5.808～12.964,P=0.000),lowdensity re-admission Lipoprotein is not up to standard(OR=1.207,95%CI 0.997～1.309,P=0.001),systolic blood pressure after re-admission(OR=4.108,95%CI 2.985～6.011,P=0.011),first admission glycated hemoglobin(OR= 2.239,95%CI 2.025～4.537,P=0.037),total stent length(OR=1.302,95%CI 1.87～2.445,P=0.002)are independent ri sk factors for revascularization in elderly patients with coronary heart disease after PCI.Postoperative oral ticagrelor(OR=0.775,95%CI 0.216～1.412,P=0.018)is an independ ent protective factor for revascularization in elderly patients with coronary heart disease after PCI.Conclusion1.This study found that the longer the interval between two operations,the diabetes,poor systolic blood pressure control,higher or lower LDL,the longer the total length of the first implanted stent,and the larger the total diameter of the stent,the more elderly patients undergoing PCI Prone to revascularization.2.The interval between two interventions,the low-density lipoprotein of the readmission,the low-density lipoprotein of the re-admission,the systolic blood pressure of the re-admission,the glycosylated hemoglobin for the first admission,and the total length of the stent for the first operation are the second time for elderly patients with coronary heart disease after PCI.An independent risk factor for revascularization,ticagrelor is an independent protective factor for revascularization in elderly patients with coronary heart disease after PCI.3.Elderly patients with coronary heart disease after PCI should pay attention to the control of blood sugar,blood pressure,low-density lipoprotein,and try to choose oral ticagrelor antiplatelet therapy to reduce the occurrence of revascularization. |
PDF Full Text Request