不同心功能状态对接受血运重建治疗冠心病患者预后的影响

摘要

目的 探究LVEF ＞40％伴心衰的冠心病患者接受血运重建治疗的近期及远期预后.方法 连续入选2003年7月1日至2005年9月30日在北京安贞医院接受经皮冠脉介入治疗(PCI)或冠脉旁路移植术(CABG)的3286例患者.至少随访1年,平均随访时间18个月.按照左室射血分数(LVEF)和有无充血性心力衰竭分为:A组LVEF＞ 40％并无心衰者(2022例)、B组LVEF＞ 40％伴心力衰竭者(1070例)、C组LVEF≤40％(194例).比较各组患者间的临床特征、院内、长期死亡及主要不良心脑血管事件(MACCE)的发生率.结果 67.1％患者接受PCI治疗,32.9％患者接受CABG治疗,A组患者接受PCI治疗的比例最高.LVEF＞ 40％的冠心病患者中伴有心衰的患者并不少见,占34.6％.LVEF≤40％组患者院内死亡率、长期死亡率明显高于其他两组患者.LVEF＞ 40％伴心衰者组患者院内死亡率、长期死亡率明显高于LVEF＞ 40％并无心衰者组患者.COX多因素回归分析结果显示,除LVEF≤40％组患者死亡风险是LVEF＞ 40％并无心衰组患者的2.3倍(HR2.324,95％CI0.982 ～5.728),LVEF＞ 40％伴心衰组患者死亡率是LVEF＞ 40％无心衰组患者的1.3倍(HR.275,95％CI0.792 ～2.053).结论 LVEF＞40％的冠心病患者中伴有心衰的患者并不少见死亡率高,是LVEF＞ 40％无心衰组患者的1.3倍.%Objective To investigate short-term and long-term effect of revascularization on the patients with impaired left ventricular ejection fraction and congestive heart failure. Methods The study is a retrospective study in a single center including 3286 patiens with CAD receiving PCI or CABG from July 2003 to September 2005 at Beijing Anzhen Hospital. The patients were divided into 3 groups by left ventricular ejection fraction (LVEF) and congestive heart failure (CHF) including: patients with LVEF > 40% without CHF symptans (Group A, n=2022) , patients with LVEF >40% and CHF (Group B, n = 1070), patients with LVEF^40% (group C, n = 194). Mean follow-up period was 18 months. The clinical data and the prognosis were compared among the 3 groups, and the possible variables correlating with mortality were analyzed by COX regression. Results A 67. 1% of patients received PCI and 32. 9% of patients received CABG. The percentage of patients in group A receiving PCI was higher among the 3 groups (75.7% P <0. 001). There was 34.6% patients with LVEF >40% presencted CHF. The patients in Group C (LVEF ?S4O% ) had the highest in-hospital and follow up mortality. Patients in Group A (LVEF > 40% and CHF) had higher in-hospital and follow-up mortality than Group B (LVEF >40% without CHF). COX regression analysis showed that patients with LVEF $40% had highest risk of mortality (HR 2. 324, 95% CI0. 982 -5. 728) and patients with LVEF >40% and CHF had second highest risk of mortality (HR 1. 275,95% CI 0. 792 - 2.053). Conclusions CAD complicated by CHF with LVEF > 40% is common and associated with a 1.275 fold higher mortality compared with LVEF > 40% without CHF. Medical treatments are not optimized in these patients.