不同血运重建方式对冠心病合并非重度左心功能不全患者预后的影响

The effect of different approaches of revascularization on the prognosis of no severe left ventricular dysfunction

目的比较经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)对冠心病合并非重度左心功能不全患者预后的影响。方法选择2011年1月至2013年1月在首都医科大学宣武医院住院的冠心病合并非重度慢性心力衰竭行血运重建患者412例为研究对象,根据血运重建方式分为PCI组268例和CABG组144例。随访截止至2016年1月,随访主要终点事件为全因病死率,次要终点事件为非致死性心肌梗死、再次血运重建及主要不良心血管事件(MACE)发生率,比较PCI组与CABG组长期预后的差别。结果随访时间5(3,6)年,其中PCI组失访28例(10.4%),CABG组失访17例(11.8%)。住院期间总MACE、死亡、非致死性心肌梗死、靶血管血运重建(TVR)发生率两组间比较,差异无统计学意义(P>0.05);心功能变化比较,PCI组有效比例高于CABG组,无效比例PCI组低于CABG组(P<0.05)。随访期间,PCI组累积全因病死率低于CABG组(7.8%vs.19.4%,P<0.05),总MACE发生率低于CABG组(38.1%vs.43.8%,P<0.05);PCI组累积非致死性心肌梗死发生率、累积TVR率与CABG组的差异无统计学意义(P>0.05)。Cox模型多因素分析矫正后,PCI组总MACE发生率(HR=1.357,95%CI 1.105~1.729),全因病死率(HR=0.426,95%CI 0.121~0.753)仍低于CABG组(P<0.05);TVR率、非致死性心肌梗死的差异无统计学意义(P>0.05)。结论冠心病合并非重度心功能不全患者行PCI安全有效,与CABG组相比心功能改善更明显,可降低全因病死率和MACE。

Objective To compare the prognosis of percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） for the treatment of no severe left ventricular dysfunction patients. Methods The clinical data of 412 patients admitted to Xuanwu Hospital from January 2011 to January 2013 with no severe left ventricular dysfunction were retrospectively reviewed. Among the patients, 268 underwent PCI and 144 received CABG. Patients were followed up to January 2016, all-cause mortality, nonfatal myocardial infarction and revascularization were recorded and compared between the two groups. Results Compared with the CABG group, PCI group had significantly higher probability of heart function improvement （P〈0.05）. Being followed up for 3-6 years, 28 patients（10.4%） were loss of follow up in PCI group, 17 patients（11.8%） were loss of follow up in CABG group. Before regression adjustment all-cause mortality was 7.8% for PCI and 19.4% for CABG（P〈0.05）, the total major adverse cardiovascular events （MACE） was 38.1% for PCI and 43.8% for CABG（P〈0.05）. Nonfatal myocardial infarction, target vessel revascularization（TVR） had no difference between the two groups（P〉0.05）. After regression adjustment by Cox analysis, the total MACE （HR=1.357, 95%CI 1.105-1.729）, allcause mortality （HR=0.426, 95%CI 0.121-0.753） were remarkable lower in PCI than CABG group. Conclusion PCI for no severe left ventricular dysfunction patients can improve the prognosis and reduce the all-cause mortality and MACE.