冠心病心力衰竭患者血运重建术后心脏性猝死的危险因素评估——CRISIS临床研究

摘要

目的 探讨冠心病心力衰竭患者血运重建术后心脏性猝死(sudden cardiac death,SCD)的高危因素.方法 回顾性分析首都医科大学附属北京安贞医院2005年1月至2014年12月1683例行血运重建术且术前30 d内左心室射血分数(LVEF)≤40％的冠心病心力衰竭患者,根据随访期间是否发生SCD分为SCD组(59例)和无SCD组(1624例),评估住院期间临床基线资料、超声心动图、血管病变及用药情况.结果 本研究平均随访(1803±994)d.Cox回归分析发现,三尖瓣反流(HR 2.217,95％CI 1.285～3.827,P=0.004)、左主干+三支病变(HR 3.089,95％CI 1.310～7.283,P=0.010)、尿酸(HR 1.003,95％CI 1.001～1.005,P=0.006)为SCD的独立预测因素.结论 尿酸、冠状动脉左主干+三支病变、三尖瓣反流是冠心病心力衰竭患者血运重建术后发生SCD的独立预测因素.%Objective To explore the risk factors for sudden cardiac death(SCD)after revascularization in patients with coronary heart disease and heart failure.Methods This study was a retrospective analysis of 1683 patients with coronary heart disease whose left veatricalar ejection fraction(LVEF)≤40％within 30 days before revascularization.Patients were categorized into 2 groups according their clinical outcome as with or without SCD.Their clinical,angiographic and echocardiographic characteristics were reviewed and compared.The average follow-up time was 1803 days.Results There were total 59 SCD cases.The Cox regression analysis revealed that tricuspid regurgitation(HR 2.217,95％CI 1.285-3.827,P=0.004),lef t main with triple-vessel disease(HR 3.089,95％CI 1.310-7.283,P=0.010),uric acid levels(HR 1.003,95％CI 1.001-1.005,P=0.006)were independent risk factors of SCD.Conclusions The risk of sudden cardiac death after revascularization in coronary artery disease patients with heart failure were significantly higher in patients with tricuspid regurgitation,left main with triple-vessel disease and high uric acid levels.