| Objective: Analysis of patients with acute coronary syndrome after percutaneous coronary artery interventional therapy of carotid plaque reversal for prognostic influence of patients of carotid artery plaque reversal degree to the predictive value of prognosis in the patients with ACS after PCI.Methods: From January 2014 to December 2016,354 patients [mean age(62.1 ± 9.6)yrs,215 males] who received percutaneous coronary intervention(PCI)for the first time were hospitalized for acute coronary syndrome(ACS)were enrolled in the study.All the patients were divided into two groups according to carotid artery plaque reversal degree(one year after PCI,carotid plaque area PCI preoperative carotid plaque area /PCI preoperative carotid plaque area): carotid artery plaque significantly reversed group(group A)and no significant reversal of carotid artery plaque two group(group B),with 3% as the boundary.During hospitalization,percutaneous coronary intervention(PCI)was performed to open one or more occlusive or stenotic coronary arteries,and the immediate residual SYNTAX score(rSS score)after PCI were calculated.All patients were followed up for 1 years,and the incidence of MACE(non fatal myocardial infarction,re revascularization,cardiogenic death)after PCI was statistically analyzed.The height and weight of the patients were measured at 1 years after PCI,and BMI was calculated,and the biochemical whole and carotid artery ultrasound were reviewed.Coronary angiography was reviewed 1 years after the operation,and the SYNTAX score was calculated.Results: A total of 354 patients were enrolled in ACS.There were no differences between A group and B group in age,gender,smoking history,history of hypertension,history of diabetes,PCI preoperative body mass index(BMI0),PCI preoperative blood uric acid(UA0),low density lipoprotein cholesterol(LDL-C0),high density lipoprotein cholesterol(HDL-C0),high sensitive C the reaction protein(hs-CRP0)and other general data showed no significant difference.PCI was performed in all two groups,and no significant difference was found between the immediate residual coronary artery SYNTAX scores(rSS)after PCI.Meanwhile,in group A and group B,low density lipoprotein cholesterol in two groups(LDL-C1),high density lipoprotein cholesterol(HDL-C1)and SYNTAX score(rSS1)compared with no obvious differences,and body mass index(BMI1),uric acid(UA1)and high sensitive C reactive protein(Hs-CRP1),there was significant difference(P < 0.05).Patients of two groups of preoperative carotid plaque area showed no significant difference;The carotid artery plaque area of the patients in group A after PCI was significantly lower than patients in group B[(58.5 + 36)mm2 VS(48.9 + 27.6mm2),P < 0.05].The carotid plaque area of patients in group A was smaller 1 year after PCI than Pre-PCI[(48.9 + 27.6)mm2 VS(57.4 + 34.3)mm2,P < 0.05].All of the patients after 1 years of follow-up,there were 19 cases with non fatal myocardial infarction,10 cases with revascularization,total non lethal MACE total of 29 cases in group A,while 35 cases of non fatal myocardial infarction,15 cases of revascularization,total non fatal MACE in 50 cases in group B,non lethal MACE incidence of A group was significantly lower than that of B group(P < 0.05).The Kaplan-Meier survival curve was used to show the incidence of fatal MACE in two groups of patients.Patients with non lethal MACE after 1 years of PCI were analyzed.There were no significant difference in age,hypertension,diabetes,smoking history,preoperative BMI(BMI0),uric acid(UA0),high density lipoprotein cholesterol(HDL-C0),high sensitive C reactive protein(Hs-CRP0),uric acid 1 years after the operation(UA1),high density lipoprotein cholesterol(HDL-C1),and preoperative carotid plaque area of carotid plaque area 1 years after PCI.There were significant difference in sex,preoperative low density lipoprotein cholesterol(LDL-C0),BMI 1 years after operation(BMI1),uric acid(UA1),low density lipoprotein cholesterol(LDL-C1),high sensitive C reactive protein(Hs-CRP1)and carotid plaque area reversal rate(P < 0.05).Using Cox multivariate analysis to correct gender,1 year postoperative BMI,uric acid and high-sensitivity C reactive protein,plaque area reversal rate were independent protective factors of non fatal MACE after ACS in PCI patients(RR=0.000,95% CI 0.000-0.090,P = 0.005).The predictive value of UA1,plaque area reversal rate,BMI1 and gender for MACE in patients with ACS after ROC were compared by using the ROC curve.The area under the ROC curve was 0.429(UA1),0.635(plaque area inversion rate),0.368(BMI1),and gender(0.590).Delta rSS is defined as the SYNTAX score of 1 years after PCI minus the immediate SYNTAX score after PCI,that is,rSS1-rSS0.A total of 25 patients in 354 patients underwent revascularization(SYNTAX score change)during the follow-up period,and 149 patients had no significant change in SYNTAX score(delta rSS=rSS1-rSS0=0).There were 68 cases of delta rSS > 0,and 112 cases of delta rSS < 0.The delta rSS is less than 0 of patients with rSS > 0 compared with that of two groups of patients in age,hypertension,diabetes,preoperative BMI(BMI0),uric acid(UA0),low density lipoprotein cholesterol(LDL-C0),high density lipoprotein cholesterol(HDL-C0),high sensitive C reaction protein(Hs-CRP0)and uric acid in 1 years after PCI(UA1),low density lipoprotein cholesterol(LDL-C1),high density lipoprotein cholesterol(HLD-C1),high sensitive C reactive protein(Hs-CRP1),preoperative carotid plaque area had no significant difference,while in the smoking history,after 1 years of BMI and 1 years after surgery,carotid plaque area,carotid plaque area reversal rate was significant differences(P < 0.05).There was also significant difference in the incidence of non lethal MACE(P < 0.05).Conclusion: Reversal degree and operation in 1 ACS patients,PCI postoperative carotid plaque after 1 years at BMI,UA and Hs-CRP.The degree of carotid artery plaque reversal was positively correlated with the improvement of coronary artery SYNTAX score in patients with ACS after PCI.The prognosis of acute coronary syndrome(ACS)patients with obvious reversal of carotid plaque after percutaneous coronary intervention(PCI)is better,and the SYNTAX score of coronary artery is improved more significantly.The incidence of non fatal MACE after PCI is significantly lower in ACS patients with obvious reversal of carotid plaque.The rate of plaque area reversal is an independent protective factor for non fatal MACE after ACS in PCI patients. |
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