血运重建治疗对冠心病合并心力衰竭患者预后的影响

Effect of coronary revascularization on the prognosis of patients of coronary artery disease complicated with heart failure

目的探讨冠脉血运重建治疗对冠心病合并心衰患者预后的影响。方法对1163例行冠脉血运重建治疗(包括PCI和CABG)的冠心病合并心衰的患者进行回顾性分析,按左室射血分数是否正常(定义为LVEF≥50%)将患者分为左室射血分数正常组(LVEF≥50%,920例)和左室射血分数降低组(LVEF<50%,243例),分别评价患者住院期间的临床、血管造影、超声心动图等相关资料并对患者进行长期随访。平均随访时间为548天,一级终点为全因死亡率。结果左室射血分数正常组和左室射血分数降低组在住院期间死亡率差异无统计学意义(χ2=2.105,P=0.147),在随访期间累积生存率差异也无统计学意义(logrank统计值2.134,P=0.161)。Cox回归分析发现,患者年龄(HR1.093,95%CI1.040～1.148,P<0.001)为影响患者死亡的独立预测因子。结论影响行血运重建治疗的冠心病合并心衰患者的预后因素为患者年龄;在这些患者中,左室射血分数正常组和左室射血分数降低组患者临床预后相似。

Objective To explore the effect of coronary revascularization on the prognosis of the patients of coronary artery disease （CAD） complicated with heart failure. Methods This was a single-center retrospective study of 1,163 patients with chronic heart failure and documented CAD. We assessed clinical, angiographic and echocardiographic characteristics, and prognosis after coronary revascularization （PCI or CABG） in those with preserved （ ≥50% ） or reduced （ 〈50% ） LVEF. Heart failure patients were divided into two groups： 243 with reduced EF （HFREF） and 920 with preserved EF （HFPEF）. The average follow- up was 548 days. The primary outcome was death of all cances. Results The death during in-hospital period between the HFPEF and the HFREF group was of no significance （X2 = 2. 105, P = 0. 147 ）. The cumulative survival during follow-up had no difference between the two groups （log rank = 2. 134, P = 0. 161 ）. Age （HR 1. 093, 95% CI 1. 040 - 1. 148, P 〈 0. 001 ） was significantly related to the death rate during follow-up. Conclusions The factor affecting prognosis in coronary artery disease patients complicated with heart failure after coronary revascularization is age. Patients with HFPEF may have a similar prognosis after coronary revascularization than those with HFREF.