血运重建程度对冠心病合并左心功能不全患者经皮冠状动脉介入治疗术后长期预后的影响

目的观察冠心病合并左心功能不全患者的临床特点,并探讨血运重建程度对人群经皮冠状动脉介入治疗(PCI)术后长期预后的影响。方法回顾性分析2005年3月~2012年1月住院治疗的97例左室射血分数(LVEF)≤40%的PCI术后患者的资料,按照血运重建程度分为完全血运重建组(54例)和不完全血运重建组(43例)。比较两组患者基线资料,经倾向评分匹配校正基线资料后,通过随访了解远期主要心脑血管不良事件,使用Kaplan-Meier生存曲线和Log-Rank检验进行生存分析,使用Cox回归模型分析多因素与预后的关系。结果与完全血运重建组相比,不完全血运重建组EuroSCORE、Gensini积分、既往心肌梗死病史和3支病变比例较高,差异有统计学意义,随访期间不完全血运重建组全因死亡率高于完全血运重建组,Kaplan-Meier生存曲线显示完全血运重建组累积生存率优于不完全血运重建组,两组远期无主要心脑血管不良事件(MACCE)生存率无统计学差异。结论完全血运重建可以降低远期死亡率,尤其是PCI术后2年完全血运重建获益显著。因此,应尽量实现完全血运重建,以改善冠心病合并左心功能不全患者的远期预后。

Long-term benefit of complete revascularization in coronary artery disease patients with left ventricular dysfunction after percutaneous coronary intervention

Objectives To observe the clinical characteristics and investigate the long-term prognostic implications of the revascularization level in coronary artery disease patients with left ventricular dysfunction after pereutaneous coronary intervention. Methods Between April 2005 and January 2012,97 patients with left ventricular ejection fraction ≤ 40% underwent pereutaneous coronary intervention, 54 patients obtained complete revascularization （CR）, and the other 43 patients underwent incomplete revascu- larization （ICR）. The baseline clinical features ,laboratory data, echocardiograph and coronary angiography parameters of CR and ICR groups were compared. By adjusting the baselines with a propensity score matching analysis,long-term outcomes including main adverse cardiac and cerebral events （MACCE） were observed. The survival analysis in the two groups was performed with Kaplan- Meier curve and Log-Rank test. Cox regression analysis was used to analyze the multiple prognosis factors. Results In comparison with CR group,ICR group had significantly higher levels of EuroSCORE （5.74± 2.19 vs 7.51 ± 3.69,P 〈 0.05）,Gensini score （107.72 ± 52.64 vs 64.74 ± 36.58,P 〈 0.05）,history of myocardial infarction （60.5% vs 37.0%,P 〈 0.05） and triple vessel disease （53.5% vs 20.4%,P 〈 0.05）,During a 3-year follow-up,ICR group had more prior all-cause mortality than CR group （48.8% vs 18.5%, P 〈 0.05）. Kaplan-Meier curve showed that CR group had higher cumulative survival rate than ICR group;the event-free survival rate between the two groups had no statistical difference. Conclusion Complete revascularization can effectively reduce all-cause mortality,especially 2 years after percutaneous coronary intervention;it will be performed in order to improve the prognosis of coronary artery disease oatients with left ventricular dysfunction.