李琪,王伟民,刘健,曹成富,宋俊贤,张静,马玉良,赵红,卢明瑜,侯昌

• 1:北京大学人民医院心内科

摘要(Abstract)：

目的 探讨对不稳定型心绞痛患者采用完全血运重建对其心功能和中长期预后的影响。方法 连续纳入2019年1—12月于北京大学人民医院心内科行经皮冠状动脉介入治疗（PCI），诊断为不稳定型心绞痛并进行6个月以上的临床随访和超声心动图随访的患者276例。根据冠状动脉造影、腔内影像学和血流储备分数（FFR）结果判断冠状动脉病变是否为有血运重建意义的病变，对所有有血运重建意义的病变进行介入治疗分入完全血运重建组共202例，未对所有有血运重建意义的病变进行介入治疗分入非完全血运重建组共74例。比较两组患者的临床资料、病变特点、手术情况、左心室射血分数（LVEF）恶化率、不良心血管事件发生率等情况。结果 完全血运重建组与非完全血运重建组患者多支病变比例（51.5%比94.6%,P<0.001）及使用腔内影像学指导PCI比例（16.3%比6.8%,P=0.041）比较，差异均有统计学意义。完全血运重建组与非完全血运重建组患者在随访期间出现LVEF恶化率（0.5%比6.8%,P=0.001）、再次血运重建率（9.4%比24.3%,P=0.013）、再发心肌梗死发生率（1.5%比12.2%,P=0.001）、心力衰竭恶化住院率（5.4%比28.4%,P<0.001）及总不良事件发生率（14.4%比43.2%,P<0.001）比较，差异均有统计学意义。两组中各发生1例心原性死亡，差异无统计学意义（P=0.548）。多因素Cox回归分析发现，平均每例置入支架数（OR 1.572,95%CI 1.152～2.960,P=0.047）、完全血运重建（OR 10.314,95%CI 1.011～20.662,P=0.012）是LVEF恶化的独立相关因素。结论 完全血运重建可改善不稳定型心绞痛患者的中长期的心功能，并能减少不良心血管事件。

关键词(KeyWords)： 不稳定型心绞痛;心功能;经皮冠状动脉介入治疗;完全血运重建;不完全血运重建

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 李琪,王伟民,刘健,曹成富,宋俊贤,张静,马玉良,赵红,卢明瑜,侯昌

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