稳定型冠心病患者经皮冠状动脉内介入治疗术后使用β阻滞剂不能降低全因死亡及主要不良心血管事件风险

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Abstract：Objective Toexploretheassociationbetween theuseof β -blockersandtherisksofall-causemortalityand major adversecardiovascular events （MACEs）inpatientswith stablecoronaryartery disease （SCAD）after percutaneous coronary intervention （PCI）.Methods Weperformed secondaryanalysesof thedataof 55SCADpatients receivingpost-PCI β -blocker treatment and 149 patients without post-PCI β -blockers （control group） from the Dryad database. The clinical and coronary arterydiseasechracteristicsofthepatientswereanalyzed，andpropensitycorematchingwasusedtocompareal-cause mortalityandACEs （includingcardiovasculardeath，non-fatalmyocardialinfarctionandnon-fatalstroke）betweenthetwo groups. Results The overall patients （ 69.6% were male） had a mean age of 72.6±10.3 years with a median follow-up time of 783 days.Atotalof18patients （8.8%） died，andMACEsoccurredin19patients （9.3%） ，includingcardiovasculardeathin6cases （2.9%） ，non-fatal myocardial infarction in3cases （1.5%） andnon-fatal strokein11 cases （5.4%） . In the β -blocker group， deaths occurredin5cases （9.1%） andMACEsin4cases （7.3%） ，including2caseswithcardiovasculardeath （3.6% and2caseswith non-fatal stroke （3.6%） .Kaplan-Meiersurvivalcurveanalysisshowedthattheuseof β -blockersafterPCIwasnotassociated withareducedall-causemortality 8.7% Us 9.1% log-rank P=0.870 ）orincidenceofMACEs 10.1% Us 7.3% log-rank P=0.510 0 eitherbeforeorafterajustingforage，sex，aspartateaminotransferase，estimatedglomerularfiltrationrate，leftvnticular ejection fraction，andhistory ofatrial fibrillation （HR=0.81， 95% CI： 0.24-2.72;HR=0.62， 95% CI： 0.22-1.69）. No significant diferences werefoundinall-ausedeathorMACEsbetweenthetwogroupsafter propensityscoreadjustment，matchingor IPTW inverse probability weighting （all P>0.05 ）. Conclusion Routine use of β -blockersafter PCI does not reduce the incidence of all-cause death or MACEs in patients with SCAD.

Keywords：stablecoronaryarterydisease;percutaneouscoronaryintervention; β -blockers;all-causemortality;majoradverse cardiovascular events

利用全球疾病负担数据进行的一项研究表明，2025～2050年，心血管疾病患病率预计将增加 90.0% ，粗死亡率预计将增加 73.4% ，粗伤残调整寿命年预计将增加 54.7% ，预计2050年将有3560万例心血管疾病死亡（2025年为2050万例），2050年，缺血性心脏病仍将是心血管死亡的主要原因（2000万例死亡）。（剩余12889字）