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本研究旨在评价红细胞分布宽度(red blood cell distribution width,RDW)对植入药物洗脱支架(drugeluting stents,DES)的非ST段抬高急性冠脉综合征患者(non-ST elevation myocardial infarction,NSTE-ACS)远期预后的影响。研究纳入南方医科大学珠江医院2013年2月1日至2014年1月31日在心内科行经皮冠状动脉介入术(percutaneous coronary intervention,PCI)并植入DES的NSTE-ACS患者共181名,其中男性136例,女性45例,按照入院时的RDW的中位数分为2组;RDW≥13.3%为高RDW组,RDW<13.3%为低RDW组。收集患者的相关临床资料采用门诊、电话等形式进行随访,比较两组患者之间长期生存率。纳入符合条件的患者181例,完成随访177例(97.8%),随访时间(14.67±5.78)月。2组患者基线资料中RDW血小板,受体阻滞剂(BETA BLOCK)比较,差异有统计学意义。高、低RDW两组患者随访结果显示,高RDW组全因死亡率及主要心脏不良事件(major adverse cardiac events(MACE))发生率与低RDW组比较有统计学差异,随访期间内靶血管再次血运重建的概率两组有统计学差异。Cox多元回归分析显示RDW升高是全因死亡和MACE发生率的预测因子,高RDW和LVEF≤40%与病死率相关。Kaplan-Meier曲线显示两组间全因死亡率和MACE事件发生率差异有统计学意义(Log-rank p=0.025,p=0.005)。本研究结果显示RDW升高是植入药物洗脱支架的NSTE-ACS患者不良临床预后的独立预测因子。
The purpose of this study was to evaluate the effect of red blood cell distribution width (RDW) on non-ST elevation myocardial infarction (DES) patients with non-ST-segment elevation acute coronary syndromes implanted with drug-eluting stents (DES) NSTE-ACS) long-term prognosis. METHODS: A total of 181 NSTE-ACS patients admitted to the Southern Medical University Zhujiang Hospital from February 1, 2013 to January 31, 2014 underwent percutaneous coronary intervention (PCI) and DES were enrolled. Among them, male 136 cases and 45 females were divided into two groups according to the median of RDW on admission; RDW≥13.3% of high RDW group, RDW <13.3% of low RDW group. The clinical data of the patients were collected by follow-up in the form of clinic, telephone and so on. The long-term survival rate was compared between the two groups of patients. A total of 181 eligible patients were enrolled. A total of 177 (97.8%) follow-up visits were completed (14.67 ± 5.78) months. There was statistically significant difference between the two groups in baseline data of RDW platelets and receptor blockers (BETA BLOCK). The follow-up results of high and low RDW patients showed that the incidence of all-cause mortality and major adverse cardiac events (MACE) in the high RDW group were significantly different from those in the low RDW group. During the follow-up period, The probability of revascularization was statistically different between the two groups. Cox multivariate regression analysis showed that elevated RDW was a predictor of all-cause mortality and MACE incidence, and high RDW and LVEF ≤40% were associated with mortality. The Kaplan-Meier curve showed a statistically significant difference in all-cause and MACE events between the two groups (Log-rank p = 0.025, p = 0.005). The results of this study show that elevated RDW is an independent predictor of adverse clinical outcomes in patients with NSTE-ACS implanted with drug-eluting stents.