The Long-term (＞5 Years) Following-up Study And Analysis Of Influencing Factors In Coronary Heart Disease Patients After Revascularization

Background and objective:There are three main treatment methods for coronary heart diseases(CHD),including medicine therapy, PCI and CABG. Little data on the long-term prognosis and efficiency of CHD patients from "real world" cohort by following-up study could be found in China. This essay is aimed to explore main risk factors that have important influences on prognosis of CHD cohort and compare the results of different treatment strategies and further to analyze the main risk factors on prognosis of the DES subgroup, by means of 5-year following-up study of the definite CHD patients after revascularization.Method:A total of 426 CHD patients who received revascularization operations(PCI or CABG) from January 2004 to March 2006 were selected in the study and followed-up by telephone,rehospitalization and mail. This is a single-centre and non-control study. Grouping according to different treatment strategies and SYNTAX score is aimed to observe whether significant difference is existed in patients'clinical characteristics, examination results, operation information and follow-up results (MACCE) between groups.Results:A sum of 426 patients finished over 5-year following-up. The average time of following-up was 60.59±6.15 months (mean 60 months). The average age was 59.68±10.82 years and age from 31 to 84. The study cohort included 351 males(82.4%)and 75 females (17.6%), which the former was much higher than the latter in proportion,333 with PCI and 93 patients with CABG. Cox regression model analysis in total cohort showed:OMI (β=3.98,p=0.004, OR=53.47,95%IC:3.59-795.74),srtoke(β=5.43,p=0.001, OR=228.31,95%IC: 8.21-635.36),arhythmia (β=6.37, p=0.008, OR=586.44,95%IC: 5.44-6319.54),smoking (β=1.6, p=0.016, OR=4.95,95%IC:1.34-18.31),hypertension (β=2.78, p=0.002, OR=16.18,95% IC:2.75-95.04) and the amount of lesion vessel (β=3.029,p=0.002, OR=20.67,95%IC:3.056-139.829) were main risk factors of MACCE incidence. Survival curve dropped sharply in the 1st year and 4-5th years after the revascularization during the following-up. By comparing prognosis results among different treatment trategies of DES implantation and CABG operation,CABG group had more complicate clinical characteristics and pathological changes, but higher free-MACCE survival rate and lower re-angina pectoris than the another one, which was attributed to complete revascularization. The COX regression model analysis of the DES subgroup showed that NYHA three-four grade (β=0.993,p=0.037, OR=2.701, 95%IC:1.06-6.877),systolic pressure (β=-0.029,p=0.044, OR=0.972,95% IC 0.945-0.999),body mass index (β=0.159,p=0.041, OR=1.172,95%IC: 1.006-1.366) and complete revascularization (β=1.242,p=0.038, OR=3.463, 95%IC:1.071-11.195) were main predictors of MACCE incidence.Conclusion:The incidence rate of MACCE appeared higher in the first year and in the fourth-fifth year after the operation. Therefore, the incidence rate of MACCE would drop obviously in the secondary prevention for patients suffering coronary heart disease if the follow-up and recheck work could be carried out in these two important periods. The long prognosis showed that relieving symptom in CABG revascularization was more complete and lasting,the long survival rate higher than other operations. According to recent ESC and AHA/ACC guidelines for conorany revascularization criteria, For MVD,complex 3-VD,unobtainable complete revascularization, LM disease with co-existing proximal LAD,higher SYNTAX score, CABG may be more advisable and reasonable operation selection. Complete revascularization for disease conorary vessels as possible will make the prognosis of CHD cohort better.