2019 年第 1 期 第 14 卷

急性冠状动脉综合征合并恶性肿瘤患者经皮冠状动脉介入术后远期预后的研究

Long-term outcomes of patients with acute coronary syndrome complicated with cancer undergoing percutaneous coronary intervention

作者：马越刘放孙岩马晓腾吕赛程宇婧杜俣杨丽霞王志坚梁静周志明周玉杰

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心

英文单位：

关键词：肺肿瘤；急性冠状动脉综合征；经皮冠状动脉介入；心血管预后

英文关键词：

• 摘要：

• 【摘要】目的    探讨行经皮冠状动脉介入（PCI）治疗的急性冠状动脉综合征(ACS)合并肺癌与合并其他恶性肿瘤患者基线特征和远期预后的差异。方法    回顾性选择2014年1月至2016年12月于首都医科大学附属北京安贞医院行PCI治疗的ACS合并恶性肿瘤成年患者233例，根据合并恶性肿瘤类型分为ACS合并肺癌组（42例）和ACS合并其他肿瘤组（191例）。收集2组患者人口学资料、相关既往史资料、心血管危险因素和恶性肿瘤相关病史资料、PCI相关资料、随访远期预后终点事件等资料。结果    ACS合并肺癌组患者男性比例以及既往放疗史和化疗史比例均高于ACS合并其他肿瘤组［83.3%(35/42)比60.2%（115/191），31.0%(13/42)比12.0%（23/191），40.1%(17/42)比23.0%（44/191）］，差异均有统计学意义（均P＜0.05）。2组患者年龄、体重指数、既往病史、辅助检查和药物治疗等基线资料比较差异均无统计学意义（均P＞0.05）。ACS合并肺癌组冠状动脉特殊病变中钙化病变比例高于ACS合并其他肿瘤组［26.2%(11/42)比13.1%（25/191）］，差异有统计学意义（P＜0.05）。2组患者ACS类型、病变血管数目、药物洗脱支架置入率、支架置入数目和其他冠状动脉特殊病变比例比较差异均无统计学意义（均P＞0.05）。在平均（2.4±0.9）年的随访中，233例患者中有32例（13.7%）失访。ACS合并肺癌组患者心血管病死率高于ACS合并其他肿瘤组［8.1%(3/37)比1.2%（2/164）］，差异有统计学意义（P＜0.05）。2组患者主要心脑血管不良事件、全因死亡、肿瘤死亡、心源性休克、心血管原因再入院等远期随访事件发生率比较差异均无统计学意义（均P＞0.05）。结论    肺癌在ACS接受PCI治疗的患者中具有不可忽视的患病率，与合并其他肿瘤相比，远期心血管病死率较高。

• 【Abstract】Objective    To investigate the differences between lung cancer and other cancers in acute coronary syndrome(ACS) patients undergoing percutaneous coronary intervention（PCI） in terms of baseline characteristics, procedural characteristics and long-term outcomes. Methods    Totally 233 adult ACS patients with cancer who underwent PCI in Beijing Anzhen Hospital, Capital Medical University from January 2014 to December 2016 were included. They were divided into 2 groups according to the cancer types: ACS with lung cancer group(n=42) and ACS with other cancers group(n=191). Baseline data, previous medical history, cardiovascular risk factors, history of cancer, procedural records of PCI and long-term follow-up data were analyzed. Results    Male rate, rates of previous radiotherapy and chemotherapy in ACS with lung cancer group were higher than those in ACS with other cancers group［83.3%(35/42) vs 60.2%(115/191), 31.0%(13/42) vs 12.0%(23/191), 40.1%(17/42) vs 23.0%(44/191)］（all P＜0.05）. There were no significant differences of age, body mass index, previous history of illness, accessory examination and drug treatment between groups(P>0.05). Incidence of coronary artery calcification in ACS with lung cancer group was higher than that in ACS with other cancers group［26.2%(11/42) vs 13.1%(25/191)］（P＜0.05）. There were no significant differences of ACS type, number of diseased vessels, drug-eluting stent implantation rate, number of stents and other types of special coronary artery lesions between groups(P>0.05). During (2.4±0.9) years of follow-up, 32 patients(13.7%) were lost. Cardiovascular mortality in ACS with lung cancer group was higher than that in ACS with other cancers group［8.1%(3/37) vs 1.2%(2/164)］(P<0.05). There were no significant differences of the incidences of major adverse cardio-cerebrovascular events, all-cause mortality, cancer mortality, cardiogenic shock and cardiovascular readmission between groups(all P>0.05). Conclusion    Lung cancer shows a high prevalence in ACS patients undergoing PCI with poor long-term cardiovascular outcomes.