经皮冠状动脉介入术后7例死亡患者的分析

Cause of death in patients undergoing percutaneous coronary intervention in a single-center

摘要:

目的 分析2016年解放军总医院心血管内科经皮冠状动脉介入(PCI)术后7例死亡患者的病例特点。方法 收集2016年我科接受PCI术患者人数及7例死亡患者的详细临床资料,对死亡患者的伴随疾病、冠状动脉病变情况及死亡原因进行分析。结果 我科接受PCI术7419例,总死亡率为0.10%(7/7419)较既往报道的0.59%呈下降趋势,其中接受急诊PCI术398例,死亡1例,死亡率0.25%(1/398)较文献报道的2.40%明显下降；7例死亡患者年龄37~80(61±14)岁,均伴有2种及以上常见慢性病,手术前诊断为不稳定型心绞痛或心肌梗死(MI)；患者冠状动脉造影(CAG)示多支病变或钙化病变,并分别进行了PCI术及强化抗凝和抗血小板治疗,其中1例患者于术后出现胸痛等症状,因心电图无动态变化导致未及时复查CAG以进行相应处理,最终死亡。7例患者中3例于术中死亡,4例于术后3~5 d死亡；死亡原因为脑出血、心脏破裂、支架内血栓或严重心功能不全。结论 择期手术患者死亡的原因与患者病变严重程度直接相关,手术后强化抗凝、抗血小板治疗是发生脑出血的高危因素；前降支及回旋支双支病变建议尽量分期处理,并结合血管内影像学检查如血管内超声(IVUS)或光学相干体层成像(OCT),提高介入治疗安全性。

Abstract:

Objective To summarize the characteristics of the patients who died after percutaneous coronary intervention (PCI) in our department during 2016. Methods Total number of patients receiving PCI and detailed clinical data of 7 died patients after PCI were collected. The clinical data of those died patients including their comorbidities, coronary characteristics and causes of death were collected and analyzed. Results There were 7419 patients receiving PCI, including 398 patients receiving emergency intervention. The total mortality was 0.1%(7/7419), markly lower than reported(0.59%), and the mortality after emergency intervention was 0.25%(1/398), significantly lower than reported(2.4%). The age of the 7 died patients was 37-80 (61±14) years old, all accompanied with two or even more comorbidities. The primary diagnosis was unstable angina or myocardial infarction(MI) and coronary angiography (CAG) showed severe or complicated lesions such as multiple or calcification lesions. Seven died cases received PCI, followed by enhanced anticoagulant and antiplatelet therapy owing to the complicated lesions. Among these,1 case complained chest pain postoperatively as well as fatigue, but due to lack of electrocardiogram(ECG)change, CAG was ignored for the better treatment. Among 7 died patients, 3 cases died during surgery, while 4 cases died 3 to 5 days after surgery. The majority of the dead underwent elective surgery, and the causes of death were cerebral hemorrhage, cardiac rupture, stent thrombosis as well as severe cardiac dysfunction. Conclusion The causes of death for the patients undergoing elective surgery are directly related with the severity of their lesions. Postoperative anticoagulation and antiplatelet treatment are the high risk factors for cerebral hemorrhage. For the patients with lesions at anterior descending artery and circumflex artery, elective surgery is recommended. What’s more, intravascular imaging, such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) should be carried out to improve the safety of interventional therapy for such patients.