Control Study Of PCI And Conservative Oral Drug Therapy In The Treatment Of Patients With High Risk Of Coronary Heart Disease As Well As High SYNTAX And EUROSCORE Scores

Objective: To compare the incidence rates of adverse cardiovascular events after percutaneous coronary intervention(PCI)and drug therapy in the treatment of patients with high risk of coronary heart disease as well as high SYNTAX and EuroSC0 RE scores,to guide clinicians of the Department of Cardiology to take full consideration of the illness conditions and actual financial status of patients in the development of therapeutic strategies,so as to develop appropriate individualized treatment strategies for patients with high risk of coronary heart disease as well as high Syntax and EuroSC0 RE scores in China.Methods: in the retrospective study,101 cases of patients with high risks of coronary heart diseases and high SE scores whose SYNTAX scores > 27 and EuroSC0RE scores > 6 points were selected from those who were diagnosed of left main coronary artery diseases and(or)triple vessel diseases through Percutaneous coronary angiography in the Department of Cardiology of Bethune International Peace Hospital(of the People’s Liberation Army)from January 2014 to June 2015.Based on different treatment methods they underwent,the patients were divided into two groups: drug therapy group and PCI group.The time and types of adverse cardiovascular events after discharge were recorded by consulting hospital medical records,outpatient visits or telephone follow-up.Observation indexes are as follows: first,major adverse cardiovascular event(MACE)endpoints,including all-cause death,nonfatal myocardial infarction,target vessel revascularization.Second,secondary adverse cardiovascular event endpoints,such as cardiac hypo-function,cardiac readmission and recurrent angina.The incidence rates of major adverse cardiovascular event endpoint and secondary cardiovascularevent endpoints between drug therapy group and PCI group were calculated,and Chi square test was adopted to determine whether the two groups had difference in the incidence rate of adverse cardiovascular event endpoint.And Kaplan-Meier analysis was performed to adverse cardiovascular endpoint events,and survival curve of adverse cardiovascular events were formulated for Log Rank(Mantel-Cox)test,and Cox proportional hazards regression analysis was performed to related risk factors.Results:1 In the 18 th month of follow-up,17 cases of patients from the drug therapy group presented MACE(accounting for 34% of total patients from the drug therapy group),and 6 cases from the PCI group presented MACE(making up 11.76% of total patients from the PCI group),indicating the difference between the two groups in the incidence rate of MACE was statistically significant,P=0.008,and the PCI group was lower than the drug therapy group in terms of the incidence rate of MACE.21 cases from the drug therapy group had cardiac hypo-function(accounting for 42% of total patients from the drug therapy group),and 10 cases from the PCI group presented cardiac hypo-function(making up 19.61% of the PCI group),suggesting that difference between the two groups in the incidence rates of cardiac hypo-function was statistically significant,P=0.015,and the PCI group was lower than the drug therapy group in terms of the incidence rate of cardiac hypo-function;25 cases from the drug therapy group had cardiogenic readmission(accounting for 50% of total patients from the drug therapy group),and 11 cases from the PCI group had cardiac readmission(making up21.57% of the PCI group),two groups of cardiac readmission was statistically significant,demonstrating that the difference between the two groups in the incidence rates of cardiac readmission was statistically significant,P=0.003,and the PCI group was lower than the drug therapy group in terms of the incidence rate of cardiac readmission;21 cases(accounting for 42% of total patients from the drug therapy group)and 9 cases(making up 17.64% of the PCI group)from the drug therapy group and the PCI group had recurrentangina,demonstrating that the difference between the two groups in the incidence rates of recurrent angina was statistically significant,P=0.007,and the PCI group was lower than the drug therapy group in terms of the incidence rate of recurrent angina.2 Kaplan-Meier results showed that mean survival time of patients who had no adverse cardiovascular events from the drug therapy group and the PCI group was 9.660±0.868 months and 12.725±0.870 months,and 95%confidence interval was(7.959-11.361 months)and(11.021-14.430 months),respectively.3 Log Rank(Mantel-Cox)result of the survival curves of the drug therapy group and the PCI group showed P=0.001,and the difference between the two groups was statistically significant.4 Stepwise regression method was adopted for Cox model analysis of related risk factors such as types of therapy,gender,smoking history,chronic lung disease,diabetes,hypertension,hyperlipaemia,SYNTAX scores and Euro SCORE,and the result of model likelihood ratio test showed P= 0.001.0.05 was included into the model and 0.10 removed from the model.The optimal model after screening contained 1 covariates: types of therapy,P=0.001,Their corresponding regression coefficient is 0.882,relative risk2.416 illustrate that SYNTAX and Euro double high score coronary heart disease in high risk patients choice drug therapy is to choose the risk of advise cardiovascular events in interventional treatment of 2.416 times.Conclusion:1 Compared with those undergoing drug therapy,the incidence rates of major and second adverse cardiovascular event endpoints of patients with high risk of coronary heart disease as well as high SYNTAX and EuroSC0 RE who undergo PCI treatment significantly decrease during long-term follow-up(6months).2 The mean survival time and median survival time of patients with high risk of coronary heart disease as well as high SYNTAX and EuroSC0 RE from the PCI treatment group are longer than that of patients from the drug therapygroup.3 SYNTAX and Euro double high score coronary heart disease in high risk patients choice drug therapy is to choose the risk of advise cardiovascular events in interventional treatment of 2.416 times.