主动脉内球囊反搏在经皮冠状动脉介入治疗中的应用

Impact and clinical outcome of intra-aortic balloon pump use during percutaneous coronary intervention

目的 探讨在中国大的冠心病中心主动脉内球囊反搏（IABP）的应用情况和对经皮冠状动脉介入治疗（PCI）患者长期预后的影响.方法 连续纳入2013年1至12月在阜外医院进行PCI治疗的冠心病患者,共10 724例,进行2年随访,记录死亡、心肌梗死、支架内血栓、再次血运重建、再发卒中等心脑血管不良事件的发生情况,比较IABP和非IABP患者的临床预后,并采用倾向性评分匹配基线资料.不良事件的多因素分析采用Cox回归分析.结果10 724例患者中共有143例置入IABP（1.3％）.与非IABP患者（10 581例）比较,置入IABP患者合并更多临床危险因素,心原性休克比率更高[9.8％（14/143）比0.2％（16/10 581）,P〈0.01],左心室射血分数更低（54.3％±11.0％比62.9％±7.2％,P〈0.01）,且冠状动脉病变更重[左主干或三支病变的比率更高（P〈0.01）,术前SYNTAX积分、靶病变数和支架总数均明显高于非IABP患者（P〈0.01）].2年随访结果提示,置入IABP患者全因死亡率明显高于非IABP患者[10.5％（15/142）比1.1％（116/10 581）,P〈0.001],心原性死亡、心肌梗死、血运重建、支架血栓和主要不良心脑血管事件的发生率也明显高于非IABP组（P〈0.001）,两组卒中和出血的发生率差异无统计学意义.Cox回归分析显示,IABP是全因死亡的独立危险因素（HR=3.51,95％CI1.71 -7.17,P=0.001）,但进行倾向性评分调整后,IABP不再是全因死亡的独立危险因素（HR=2.09,95％CI0.72 -6.13,P=0.177）.结论本中心行PCI治疗的冠心病患者IABP的使用率约为1.3％.2年临床随访结果提示,应用倾向性评分匹配基线资料后,IABP对整体PCI患者的预后未产生不良影响.

Objective To observe the impact and clinical outcome of intra-aortic balloon pump （IABP） use in patients underwent percutaneous coronary intervention （PCI）.Methods From January 2013 to December 2013,10 724 consecutive patients undergoing PCI were enrolled.After 2 years＇ follow-up,the incidence of major adverse cardiovascular and cerebrovascular events such as death,myocardial infarction,stent thrombosis,revascularization,recurrent stroke were recorded,propensity score was used to match baseline data,and the clinical outcomes in patients with IABP and non-IABP were compared.Results The overall use of IABP was 1.3% （143/10 724）,clinical and angiographic risks were significantly higher in IABP group than non-IABP group.The rate of cardiac shock was significantly higher （9.8% （14/143） vs.0.2% （16/10 581）,P〈 0.01） and left ventricular ejection fraction was significantly lower （54.3% ±11.0% vs.62.9% ±7.2%,P 〈0.01） in the IABP group than in the non-IABP group.Patients in IABP group had a significantly higher rate of left main or triple-vessel disease （P 〈 0.01）,and their SYNTAX score,target lesion number,stent number were also significantly higher compared with non-IABP patients （all P 〈 0.01）.During the 2-year follow-up,all-cause mortality was significantly higher in IABP group than in non-IABP group （10.5% （15/142） vs.1.1% （116/10 581）,P 〈 0.001）.Multivariable analyses indicated that IABP was associated with increased mortality （HR =3.51,95% CI 1.71-7.17,P =0.001）.However,after propensity score matched analyses （137 pairs）,IABP use was no longer an independent predictor of all-cause mortality （HR =2.09,95% CI 0.72-6.13,P =0.177）.Conclusions In this single large center of coronary heart disease in China,the IABP usage was about 1.3%.Propensity score matched analyses showed that during the 2 years＆#39; follow-up,adverse effect including similar long-term mortality is similar between PCI patients with or without IABP after adjusting for confounders.