血运重建史对左室功能减低的患者行冠脉介入治疗预后的影响

Impact of previous revascularization on long-term outcomes of percutaneous coronary intervention in patients with the reduced left ventricular ejection fraction

目的探讨血运重建史对左室射血分数(LVEF)小于50%的患者再次行经皮冠状动脉介入(PCI)术后远期预后的影响。方法 2013年1月至12月在阜外医院行PCI术且LVEF小于50%的患者共549例,分为有血运重建史组和无血运重建史组。比较两组术后2年不良事件的发生率并分析血运重建史与PCI术后不良事件的相关性。结果 243例(44.3%)患者有既往血运重建史。546例(99.5%)患者完成PCI术后2年随访。两组之间的全因死亡、心原性死亡、支架内血栓形成、心肌梗死、再次血运重建、靶血管重建、靶病变重建和主要心血管不良事件(MACE,包括全因死亡、心肌梗死、再次血运重建)的发生率差异均无统计学意义(P>0.05)。Cox回归分析表明血运重建史不是PCI术后2年不良事件的独立危险因素。全因死亡、心原性死亡的独立危险因素是年龄(P<0.05)。再次血运重建、靶血管重建、靶病变重建的独立危险因素为三支病变(P<0.05)。亚组分析表明,有冠状动脉旁路移植术(CABG)史的患者和有PCI史的患者行PCI术后2年的不良事件发生率与无血运重建史的患者的差异均无统计学意义(P>0.05)。结论在LVEF小于50%的患者中,既往血运重建史不增加PCI术后远期预后不良的风险。

Objective To investigate the effect of previous revascularization history on long-term outcome after percutaneous coronary intervention(PCI) in patients with a left ventricular ejection fraction(LVEF) less than 50%. Methods From January to December 2013,a total of 549 patients with a LVEF of less than 50% who underwent PCI were included in this study and were divided into a group with revascularization history and a group without revascularization history. The incidences of adverse events at 2 years after PCI were compared between groups. Cox regression was used to analyze the association between previous revascularization history and adverse events after PCI. Results A total of 243 patients(44.3%) had previous revascularization history. 546 patients(99.5%) completed a 2-year follow-up after PCI. There was no significant difference in the incidence of all-cause death, cardiac death, stent thrombosis, myocardial infarction,revascularization, target vessel revascularization, target lesion revascularization, or major adverse cardiovascular events(MACE, composite of all-cause death, myocardial infarction and repeat revascularization) between the two groups(all P>0.05). Cox regression analysis showed that the history of revascularization was not an independent risk factor of any adverse events at 2 years after PCI. The independent risk factor of all-cause death and cardiac death was age(both P<0.05).The independent risk factor of repeat revascularization, target vessel revascularization and target lesion revascularization after this PCI was triple-vessel disease(HR 1.98, 95%CI 1.12-3.48, P=0.02). Subgroup analysis showed that there was no significant difference in the incidence of adverse events at 2 years after PCI between patients with a history of CABG or those with a history of PCI and those with no history of revascularization(all P > 0.05). Conclusion In patients with a LVEF of less than 50%,previous revascularization history did not increase the risk of poor long-term prognosis after PCI.