左心室射血分数≤50%患者节段性室壁运动减低对冠状动脉慢性完全闭塞病变介入治疗远期预后的影响

Impact of Hypokinesis on Long-term Outcome of Coronary Chronic Total Occlusion Interventional Therapy in Patients With Left Ventricular Ejaction≤50%

目的:评价左心室射血分数(LVEF)≤50%合并冠状动脉慢性完全闭塞(CTO)病变患者,节段性室壁运动减低对经皮冠状动脉介入治疗(PCI)远期(5年随访)疗效影响。方法:回顾2010年1月至2013年12月于我院成功行CTO-PCI且术前LVEF≤50%患者临床资料,按CTO靶病变支配心肌节段术前超声室壁运动情况分为室壁运动正常患者(运动正常组)和节段性室壁运动减低患者(运动减低组)。随访记录临床疗效,以复合主要心血管不良事件(MACE,定义:全因死亡、心原性死亡、心肌梗死、靶血管血运重建、心力衰竭再住院、支架内血栓)为研究终点,以单项MACE作为次要研究终点。结果:共纳入228例符合研究条件患者,其中运动正常组60例,运动减低组167例。CTO血管分布两组间差异有统计学意义(P=0.03),运动减低组左前降支比例最高(58.7%),运动正常组左回旋支比例最高(41.7%)。与运动正常组比较,运动减低组5年MACE有增加趋势(36.6%vs.28.1%,P=0.32),但差异无统计学意义;经校正变量后,运动减低组和运动正常组MACE累积发生率分别为37.1%和22.9%,HR=1.41,95%CI:0.81~2.44,P_(log-rank)=0.23。结论:对于LVEF≤50%患者,节段性室壁运动减低的CTO病变介入治疗风险有增加趋势。

Objectives:To evaluate the impact of hypokinesis(left ventricular ejection fraction[LVEF]≤50%)on long-term clinical outcome of patients with chronic total occlusion(CTO)lesions after percutaneous coronary intervention(PCI).Methods:This retrospective study analyzed the clinical data of patients with LVEF≤50%who underwent successful CTO interventional therapy in Fuwai hospital from January 2010 to December 2013.Patients were divided to two groups according to the wall motion status of target CTO lesions:normal group and hypokinesis group.The primary end point was the composite of major adverse cardiovascular events(MACE),defined as death,cardiac death,myocardial infarction,target vessel revascularization,heart failure for rehospitalization rate,stent thrombosis.Results:A total of 228 cases were eligible,normal group 60 cases and hypokinesis group 167 cases.In hypokinesis group,the most frequency of CTO lesions located on left anterior descending artery(58.7%)whileas that was left circumflex artery(41.7%)in normal group.The rate of MACE at 5-year in hypokinesis group had a higher trend(36.6%vs.28.1%,P=0.32)but without significant difference comparing with normal group.The rate of MACE at 5-year in hypokinesis group had a higher trend(36.6%vs.28.1%,P=0.32)but without significant difference comparing with normal group.After correction,the cummlative rate of MACE was(37.1%vs.22.9%),HR=1.41,95%CI:0.81-2.44,P_(log-rank)=0.23.Conclusions:CTO-PCI for patients with hypokinesis in LVEF≤50%patients had a higher trend of 5-year MACE.