接受经皮冠状动脉介入治疗患者的标准可调控危险因素：患病率与影响
结果显示仅29.9%患者达4项可控，控制因素越少MACE风险越高，血糖控制与较低MACE关联最强。
要点
- PCI术前仅29.9%患者达到4项标准可调控危险因素全部控制。
- 可控危险因素数目越少，术后1年MACE风险逐步升高。
- 血糖控制与较低MACE风险的关联最为显著。
核心结论
- PCI术前全面控制标准可调控危险因素并不常见，但与较低的MACE发生率相关。
- 优先控制血糖可能对改善PCI术后预后获益最大。
研究设计与样本
- 单中心回顾性分析2012至2023年接受PCI的患者数据。
- 可控危险因素定义：收缩压<140 mmHg、空腹血糖<126 mg/dL或HbA1c<7%、LDL<100 mg/dL、不吸烟。
- 主要结局为PCI术后1年主要不良心血管事件（MACE），包括全因死亡、心肌梗死和卒中。
主要发现
- 4项可控危险因素者5876例（29.9%），3项8199例（41.7%），2项4415例（22.5%），≤1项1161例（5.9%）。
- 以4项可控者为参照，3项者MACE的adjHR 1.17（95%CI 0.98-1.40）。
- 2项者MACE的adjHR 1.39（95%CI 1.14-1.69），≤1项者adjHR 1.48（95%CI 1.10-2.00）。
- 血糖控制与较低MACE的关联最显著（adjHR 0.56，95%CI 0.49-0.65）。
临床怎么用
- PCI术前应评估并综合管理血压、血糖、血脂和吸烟等标准可调控危险因素。
- 对接受PCI的患者，血糖控制可作为改善术后预后的优先干预靶点。
局限性
- 研究为单中心回顾性分析，结果外推需谨慎。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND AND AIMS: Standard modifiable risk factors (SMuRFs), including hypertension, diabetes, hyperlipidaemia, and smoking, are prevalent among patients undergoing percutaneous coronary intervention (PCI). This study aimed to assess the prevalence and impact of controlled SMuRFs in patients undergoing PCI. METHODS: Data of patients who underwent PCI at a single tertiary-care centre between 2012 and 2023 were analysed. SMuRF control was assessed using pre-procedural measurements: systolic blood pressure <140 mmHg, fasting glucose <126 mg/dL or a haemoglobin A1c < 7%, low-density lipoprotein <100 mg/dL, and smoking status (non-smoker). Patients were stratified by the number of controlled risk factors (CRF): 4, 3, 2, and ≤1. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction, and stroke, at one-year post-PCI. RESULTS: Among 19 651 patients, 5876 (29.9%) had 4-CRF, 8199 (41.7%) had 3-CRF, 4415 (22.5%) had 2-CRF, and 1161 (5.9%) had ≤1-CRF. Compared with 4-CRF, the risk for MACE increased progressively with fewer controlled risk factors (3-CRF: adjHR 1.17, 95% CI 0.98-1.40; 2-CRF: adjHR 1.39, 95% CI 1.14-1.69; ≤1-CRF: adjHR 1.48, 95% CI 1.10-2.00). Glycaemic control had the most significant association with lower MACE (adjHR 0.56, 95% CI 0.49-0.65). CONCLUSIONS: Comprehensive SMuRF control before PCI remains infrequent, though it is associated with lower MACE rates. Prioritizing glycaemic control may yield the greatest benefit in improving post-PCI prognosis.
引用
- Nicolas J, Oliva A, Cohen R, et al. Standard modifiable risk factors among patients undergoing percutaneous coronary intervention: prevalence and impact. Eur Heart J. 2026. PMID: 42223115. doi:10.1093/eurheartj/ehag254
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。