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山东大学学报 (医学版) ›› 2025, Vol. 63 ›› Issue (8): 103-110.doi: 10.6040/j.issn.1671-7554.0.2024.1358

• 临床研究 • 上一篇    

冠状动脉血运重建术对再发急性冠状动脉综合征的风险

徐瑞泽1,2,3,王金兰4, 罗清馨1,2,3,徐朝珂2,5,吕明阅1,2,3,张硕1,2,3,严鲁宁1,2,3,胡锡峰1,2,赵青波1,2,朱高培1,2,3,李磊4, 薛付忠1,2,3   

  1. 1.山东大学齐鲁医学院公共卫生学院医学数据学系, 山东 济南 250012;2.国家健康医疗大数据研究院, 山东 济南 250003;3.山东大学齐鲁医院, 山东 济南 250012;4.山东健康医疗大数据管理中心, 山东 济南 250002;5.山东师范大学信息科学与工程学院, 山东 济南 250399
  • 发布日期:2025-08-25
  • 通讯作者: 薛付忠. E-mail:xuefzh@sdu.edu.cn李磊. E-mail:18853193737@139.com朱高培. E-mail:zhugaopei717@163.com
  • 基金资助:
    国家自然科学基金重点项目(82330108);国家自然科学基金面上项目(82173625);潍坊市中央财政支持公立医院改革与高质量发展示范项目(ZFCG-2024-0000505);河南省重大科技专项项目(241100310300)

Risk of recurrent acute coronary syndrome associated with coronary revascularization

XU Ruize1,2,3, WANG Jinlan4, LUO Qingxin1,2,3, XU Zhaoke2,5, LYU Mingyue1,2,3, ZHANG Shuo1,2,3, YAN Luning1,2,3, HU Xifeng1,2, ZHAO Qingbo1,2, ZHU Gaopei1,2,3, LI Lei4, XUE Fuzhong1,2,3   

  1. 1. Department of Medical Dataology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. National Institute of Health and Medical Big Data, Jinan 250003, Shandong, China;
    3. Qilu Hospital of Shandong University, Jinan 250012, Shandong, China;
    4. National Administration of Health Data, Jinan 250002, Shandong, China;
    5. School of Information Science and Engineering, Shandong Normal University, Jinan 250399, Shandong, China
  • Published:2025-08-25

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摘要： 目的 探讨急性冠状动脉综合征(acute coronary syndrome, ACS)患者进行冠状动脉血运重建术后再发ACS的风险。 方法 基于齐鲁全生命周期电子健康研究型数据库(Cheeloo Lifespan Electronic Health Research Data-library, Cheeloo LEAD)中被诊断为ACS的患者数据开展真实世界研究,采用基于倾向性评分匹配(propensity score matching, PSM)的队列设计方法。将接受冠状动脉血运重建术的患者作为暴露组,未接受该手术而仅进行药物治疗的患者作为对照组。通过L1正则化倾向性评分匹配控制混杂偏倚,绘制匹配前后协变量描述表和发病密度描述表进行描述性分析。绘制Kaplan-Meier(KM)生存曲线并采用Cox比例风险回归模型估计平均因果效应(average causal effect, ACE),并进行敏感性分析和亚组分析。 结果 进行L1正则化PSM后,绝大部分协变量标准化差异在0.1以下,表明匹配后组间均衡可比性大大提高。并且匹配后各协变量P值均明显升高,进一步支持匹配效果良好。在再发ACS的患者中,匹配前后男性的发病密度均比女性略高,发病年龄均主要为75~80岁。匹配后暴露组的五年生存率明显低于对照组［0.46(95%CI: 0.42~0.51)vs. 0.57(95%CI: 0.54~0.60)］,两组KM生存曲线差异有统计学意义(P<0.05)。Cox比例风险回归模型显示,冠状动脉血运重建术增加了再发ACS的风险(HR=1.38, 95%CI:1.19~1.61, P<0.05)。Schoenfeld残差检验表明,冠状动脉血运重建术满足比例风险假设(χ2=3.53,P>0.05)。敏感性分析结果以及经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)亚组分析结果与主分析结果一致,但冠状动脉旁路移植术(coronary artery bypass grafting, CABG)与再发ACS风险增加之间的关联无统计学意义(P>0.05)。 结论 进行冠状动脉血运重建术的ACS患者可能存在潜在的再发ACS风险,医生在临床中应考虑到患者个体的风险因素和可能的长期影响,权衡冠状动脉血运重建术的风险与益处,优化治疗策略并改善患者的长期预后。

关键词: 急性冠状动脉综合征, 冠状动脉血运重建术, 再发急性冠状动脉综合征, 真实世界研究, 倾向性评分匹配

Abstract: Objective To investigate the risk of recurrent acute coronary syndrome(ACS)in patients who had undergone coronary revascularization for ACS. Methods A real-world study was conducted using data from patients diagnosed with ACS in the Cheeloo Lifespan Electronic Health Research Data-library(Cheeloo LEAD), employing a cohort design based on propensity score matching(PSM). Patients who underwent coronary revascularization were classified as the exposure group, while those who did not undergo the procedure and received only drug therapy were assigned to the control group. L1-regularized PSM was used to control for confounding bias. Descriptive analyses were performed using the covariate description table and the description table of incidence density before and after matching. Kaplan-Meier(KM)survival curves were plotted, and the average causal effect(ACE)was estimated using the Cox proportional hazards regression model, and sensitivity analyses and subgroup analyses were also conducted. Results After L1-regularized PSM, the majority of standardized differences for covariates were below 0.1, indicating substantially improved post-matching balance and comparability between the groups. The P-values for covariate differences increased significantly after matching, further supporting the effectiveness of the matching procedure. Among patients with recurrent ACS, the incidence density in males was slightly higher than that in females both before and after matching, and the ages at onset were predominantly between 75 and 80 years. After matching, the five-year survival rate in the exposure group was significantly lower than that in the control group ［0.46(95%CI: 0.42-0.51)vs. 0.57(95%CI: 0.54-0.60)］, and the difference in the KM survival curves between the two groups was statistically significant(P<0.05). The Cox proportional hazards regression model showed that coronary revascularization was associated with an increased risk of recurrent ACS(HR=1.38, 95%CI: 1.19-1.61, P<0.05). The Schoenfeld residual test indicated that coronary revascularization met the proportional hazards assumption(χ2=3.53, P>0.05). The results of the sensitivity analyses and the subgroup analysis of percutaneous coronary intervention(PCI)were consistent with those of the primary analysis, whereas the association between coronary artery bypass grafting(CABG)and an increased risk of recurrent ACS was not statistically significant(P>0.05). Conclusion Patients with ACS who undergo coronary revascularization may have a risk of recurrent ACS. In clinical practice, clinicians should consider patients individual risk factors and potential long-term outcomes, weigh the risks and benefits of coronary revascularization, optimize treatment strategies, and improve the long-term prognosis of patients.

Key words: Acute coronary syndrome, Coronary revascularization, Recurrent acute coronary syndrome, Real-world study, Propensity score matching

中图分类号: 

  • R654
[1] Timmis A, Kazakiewicz D, Townsend N, et al. Global epidemiology of acute coronary syndromes[J]. Nat Rev Cardiol, 2023, 20(11): 778-788.
[2] Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes[J]. Eur Heart J, 2023, 44(38): 3720-3826.
[3] Bhatt DL, Lopes RD, Harrington RA. Diagnosis and treatment of acute coronary syndromes: a review[J]. JAMA, 2022, 327(7): 662-675.
[4] Wu YF, Li SS, Patel A, et al. Effect of a quality of care improvement initiative in patients with acute coronary syndrome in resource-constrained hospitals in China: a randomized clinical trial[J]. JAMA Cardiol, 2019, 4(5): 418-427.
[5] Smith JN, Negrelli JM, Manek MB, et al. Diagnosis and management of acute coronary syndrome: an evidence-based update[J]. J Am Board Fam Med, 2015, 28(2): 283-293.
[6] Hochholzer W, Buettner HJ, Trenk D, et al. Percutaneous coronary intervention versus coronary artery bypass grafting as primary revascularization in patients with acute coronary syndrome[J]. Am J Cardiol, 2008, 102(2): 173-179.
[7] Nohria R, Viera AJ. Acute coronary syndrome: diagnosis and initial management[J]. Am Fam Physician, 2024, 109(1): 34-42.
[8] Smolina K, Lucy Wright F, Rayner M, et al. Long-term survival and recurrence after acute myocardial infarction in England, 2004 to 2010[J]. Circ Cardiovasc Qual Outcomes, 2012, 5(4): 532-540.
[9] Yudi MB, Clark DJ, Farouque O, et al. Trends and predictors of recurrent acute coronary syndrome hospitalizations and unplanned revascularization after index acute myocardial infarction treated with percutaneous coronary intervention[J]. Am Heart J, 2019, 212: 134-143. doi:10.1016/j.ahj.2019.02.013
[10] Arnold SV, Smolderen KG, Kennedy KF, et al. Risk factors for rehospitalization for acute coronary syndromes and unplanned revascularization following acute myocardial infarction[J]. J Am Heart Assoc, 2015, 4(2): e001352. doi:10.1161/JAHA.114.001352
[11] Kim LK, Yeo I, Cheung JW, et al. Thirty-day readmission rates, timing, causes, and costs after ST-segment-elevation myocardial infarction in the United States: a national readmission database analysis 2010-2014[J]. J Am Heart Assoc, 2018, 7(18): e009863. doi:10.1161/JAHA.118.009863
[12] Song JL, Murugiah K, Hu S, et al. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China[J]. Heart, 2020, 107(4): 313-318.
[13] Gallone G, Baldetti L, Pagnesi M, et al. Medical therapy for long-term prevention of atherothrombosis following an acute coronary syndrome: JACC state-of-the-art review[J]. J Am Coll Cardiol, 2018, 72(23 Pt A): 2886-2903.
[14] 刘雪燕, 王光鹏, 姚雪, 等. 神经外科患者医院感染经济负担和住院时间分析[J]. 山东大学学报(医学版), 2021, 59(10): 87-93. LIU Xueyan, WANG Guangpeng, YAO Xue, et al. Analysis of economic burden and length of hospital stay of nosocomial infection in neurosurgery patients[J]. Journal of Shandong University(Health Sciences), 2021, 59(10): 87-93.
[15] 余恒毅, 祁星星, 方一念, 等. 基于倾向性评分匹配法评价金叶败毒颗粒与连花清瘟胶囊治疗新冠重症患者疗效的回顾性队列研究[J]. 中药药理与临床, 2023, 39(1): 66-70. YU Hengyi, QI Xingxing, FANG Yinian, et al. Efficacy of jinyebaidu granule and lianhuaqingwen capsule in the treatment of severe COVID-19 patients: a retrospective cohort study adjusted with propensity score matching[J]. Pharmacology and Clinics of Chinese Materia Medica, 2023, 39(1): 66-70.
[16] Liu N, Vigod SN, Michèle Farrugia M, et al. Venous thromboembolism after induced abortion: a population-based, propensity-score-matched cohort study in Canada[J]. Lancet Haematol, 2018, 5(7): e279-e288.
[17] Wang WJ, Wang HT, Song K, et al. Epidemiological features of infectious diseases in children and adolescents: a population-based observational study in Shandong Province, China, 2013-2017[J]. Children, 2024, 11(3): 309. doi:10.3390/children11030309
[18] Fernandes BF, Kock KS. Acute coronary syndrome in a hospital in southern Brazil: peak of hospitalizations on Mondays and severe cases on weekends and at night[J]. Am J Cardiovasc Dis, 2022, 12(6): 307-314.
[19] Bai RN, Yang QN, Xi RX, et al. The effectiveness and safety of Chinese Patent Medicines based on syndrome differentiation in patients following percutaneous coronary intervention due to acute coronary syndrome(CPM trial): a nationwide Cohort Study[J]. Phytomedicine, 2023, 109: 154554. doi:10.1016/j.phymed.2022.154554
[20] 司书成. 大数据背景下真实世界研究设计与分析策略: 以2型糖尿病药物治疗远期结局评价为例[D]. 济南: 山东大学, 2022.
[21] Deo SV, Deo V, Sundaram V. Survival analysis-part 2: cox proportional hazards model[J]. Indian J Thorac Cardiovasc Surg, 2021, 37(2): 229-233.
[22] Alan Brookhart M, Schneeweiss S, Rothman KJ, et al. Variable selection for propensity score models[J]. Am J Epidemiol, 2006, 163(12): 1149-1156.
[23] Tian YX, Schuemie MJ, Suchard MA. Evaluating large-scale propensity score performance through real-world and synthetic data experiments[J]. Int J Epidemiol, 2018, 47(6): 2005-2014.
[24] Tang GY, Qi L, Sun ZP, et al. Evaluation and analysis of incidence and risk factors of lower extremity venous thrombosis after urologic surgeries: a prospective two-center cohort study using LASSO-logistic regression[J]. Int J Surg, 2021, 89: 105948. doi:10.1016/j.ijsu.2021.105948
[25] Benedetto U, Head SJ, Angelini GD, et al. Statistical primer: propensity score matching and its alternatives[J]. Eur J Cardiothorac Surg, 2018, 53(6): 1112-1117.
[26] Gomes AP, Costa B, Marques R, et al. Kaplan-meier survival analysis: practical insights for clinicians[J]. Acta Med Port, 2024, 37(4): 280-285.
[27] Avdulla CS, Mastronikolis NS, Tachirai N, et al. Survival analysis of elderly patients with laryngeal cancer after total laryngectomy: a retrospective cohort study[J]. Cureus, 2024, 16(5): e60792. doi:10.7759/cureus.60792
[28] Kipp R, Lehman J, Israel J, et al. Patient preferences for coronary artery bypass graft surgery or percutaneous intervention in multivessel coronary artery disease[J]. Catheter Cardiovasc Interv, 2013, 82(2): 212-218.
[29] Moscarelli M, Harling L, Attaran S, et al. Surgical revascularisation of the acute coronary artery syndrome[J]. Expert Rev Cardiovasc Ther, 2014, 12(3): 393-402.
[30] De Luca L, Paolucci L, Nusca A, et al. Current management and prognosis of patients with recurrent myocardial infarction[J]. Rev Cardiovasc Med, 2021, 22(3): 731-740.
[31] Wang JL, Guo CY, Chen H, et al. Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS[J]. BMC Cardiovasc Disord, 2021, 21(1): 122. doi:10.1186/s12872-021-01933-7
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