冠状动脉介入治疗对老年无保护左主干病变合并心力衰竭患者的疗效和远期预后

Efficacy of PCI and long-term outcome in elderly unprotected left main CAD patients with HF

目的评价PCI对于老年无保护左主干病变合并心力衰竭(心衰)患者的临床疗效和远期预后。方法选择2016年1月~2019年1月解放军总医院第六医学中心心内科行PCI的老年无保护左主干病变冠心病患者99例,依据术前LVEF分为心衰组44例(LVEF≤50%),心功能正常组55例(LVEF>50%)。收集2组住院各项指标、PCI情况及随访1年结果,分析PCI对患者疗效和远期预后。结果心衰组高血压、左主干+3支病变、SYNTAX评分、支架总长度明显高于心功能正常组[56.8%vs 34.5%,P<0.05;43.2%vs 23.6%,P<0.05;(30.43±5.22)分vs(26.37±4.91)分,P<0.01;(41.33±15.35)mm vs(32.86±17.81)mm,P<0.05]。心衰组术后1年全因病死率明显高于心功能正常组,有统计学差异(P<0.05)。心衰组术后1年LVEF明显高于术前[(44.83±10.94)%vs(38.35±11.38)%,P<0.05],B型钠尿肽水平明显低于术前[(1375.76±534.43)ng/L vs(2835.35±898.78)ng/L,P<0.05]。结论内科PCI可以在患者不愿或不能耐受冠状动脉旁路移植术情况下,作为老年无保护左主干病变合并心衰患者再血管化的一项重要手段。

Objective To assess the clinical efficacy and long-term outcome of PCI in elderly unprotected left main CAD patients with HF.Methods Ninety-nine elderly unprotected left main CAD patients who underwent PCI were divided into HF group(n=44)and normal cardiac function group(n=55)according to their LVEF before operation.Their clinical,PCI and 1-year follow-up parameters were recorded.The efficacy and long-term outcome of PCI in elderly unprotected left main CAD patients with HF were analyzed.Results The incidence of hyptension and left main CAD and the SYNTAX score were significantly higher,the total stent length was significantly longer in HF group than in normal cardiac function group(56.8%vs 34.5%,P<0.05;43.2%vs 23.6%,P<0.05;30.43±5.22 vs 26.37±4.91,P<0.01;41.33±15.35 mm vs 32.86±17.81 mm,P<0.05).The all-cause mortality and LVEF were significantly higher while the serum BNP level was significantly lower in HF group than in normal cardiac function group after 1 year of operation(44.83%±10.94%vs 38.35%±11.38%,1375.76±534.43 ng/L vs 2835.35±898.78 ng/L,P<0.05).Conclusion PCI can be used as an important means of revascularization in elderly unprotected left main CAD patients with HF who are unwilling to receive or unable to tolerate coronary artery bypass grafting.