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Comparison of outcome in patients with impaired left ventricular ejection fractions having revascularization
金彦彦,马长生,康俊萍,聂绍平,张崟,吕强,刘晓惠,吴学思,胡荣
摘要(Abstract):
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(HR1.275,95%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。
关键词(KeyWords): 每搏输出量;心力衰竭;冠心病;心肌血管重建术
基金项目(Foundation):
作者(Author): 金彦彦,马长生,康俊萍,聂绍平,张崟,吕强,刘晓惠,吴学思,胡荣
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