摘要
背景:冠狀動脈疾病（CAD）是結締組織病患者發病和死亡的主要原因（CTDS）。相較於傳統的冠狀動脈疾病患者，合並結締組織病的冠心病患者的危險因素和臨床特征均不相同。本研究的目的是報告一係列接受經皮冠狀動脈介入治療（PCI）和支架植入術的患者的短期和長期的臨床預後。
方法:研究組包括2009年1月至2012年6月間連續於北京友誼醫院行PCI治療的的106例CTD患者。病曆回顧性分析的主要內容包括：臨床基本資料、冠狀動脈造影資料以及短期和長期（平均3年）隨訪期間的主要不良心髒事件發生率（MACEs）。
結果:92名患者（86.8%）有一個或多個傳統的CAD高危因素。超過2 / 3的患者（73.6%）為多支血管病變。左冠狀動脈前降支最常見的受累血管（65.1%）。共植入5個金屬支架和202個藥物洗脫支架。中位隨訪期36個月後，13例患者（12.3%）死於心源性疾病，支架內血栓形成率為9.4%，和靶血管支架內再狹窄率（TVR）為14.2%。多因素分析顯示，高血壓（風險比[HR] = 3.07，95%可信區間[ CI]：1.30 - 7.24，P = 0.041），前壁心肌梗死（HR = 2.77，95% CI：1.06 - 7.03，P = 0.04），長期的降膽固醇治療（HR = 3.60，95% CI：1.43，P = 0.032），和C—反應蛋白水平大於10毫克/升（HR = 3.98，95%可信區間：1.19–12.56，P = 0.036）均是主要心髒不良事件發生的獨立預測因子。
結論:CTD合並CAD的患者可能有嚴重的冠狀動脈病變。PCI術後的此類患者的長期隨訪中往往有更高的支架內血栓形成和TVR幾率，傳統和非傳統冠心病高危因素可能均有影響。
附原文：
Background:Coronary artery disease (CAD) is a leading cause of morbidity and mortality in patients with connective tissue diseases (CTDs). Risk factors and clinical characteristics in these patients are not equivalent to those in traditional CAD patients. The objective of this study was to report short- and long-term clinical outcomes in a consecutive series of patients with CTD who underwent percutaneous coronary intervention (PCI) with stent implantation.Methods:The study group comprised 106 consecutive patients with CTD who underwent PCI in Beijing Friendship Hospital between January 2009 and June 2012. Medical records were analyzed retrospectively including clinical basic material, coronary angiogram data, and the incidence of major adverse cardiac events (MACEs) during the short- and long-term (median 3 years) follow-up.
Results:Ninety-two of the patients (86.8%) had one or more traditional CAD risk factors. Multivessel disease was present in more than 2/3 of patients (73.6%). The left anterior descending coronary artery was the most commonly affected vessel (65.1%). Five bare-metal stents and 202 drug-eluting stents were implanted. After a median follow-up period of 36 months, thirteen patients (12.3%) died from cardiac causes, the rate of stent thrombosis was 9.4%, and the rate of target vessel revascularization (TVR) was 14.2%. Multivariate analysis revealed that hypertension (hazard ratio [HR] = 3.07, 95% confidence interval [CI]: 1.30–7.24, P = 0.041), anterior myocardial infarction (HR = 2.77, 95% CI: 1.06–7.03, P = 0.04), longer duration of steroid treatment (HR = 3.60, 95% CI: 1.43–9.08, P = 0.032), and C-reactive protein level >10 mg/L (HR = 3.98, 95% CI: 1.19–12.56, P = 0.036) were independent predictors of MACEs.
Conclusions:Patients with CTD and CAD may have severe coronary lesions. PCI in these patients tends to result in an increased rate of stent thrombosis and TVR during long-term follow-up, which may be influenced by traditional and nontraditional risk factors.
引自：Li Zhou, et，al，Short- and Long-term Outcomes in Patients with Connective Tissue Diseases Undergoing Percutaneous Coronary Intervention。Chin Med J (Engl). 2016 Apr 5; 129(7): 804–808. doi: 10.4103/0366-6999.178956.
