成功经皮冠状动脉介入治疗对冠状动脉慢性完全闭塞病变合并左心室射血分数降低患者生活质量的影响

The impact of success percutaneous coronary intervention on the quality of life of chronic total occlusion patients with reduced left ventricular ejection fraction

目的评价经皮冠状动脉介入治疗(PCI)对冠状动脉慢性完全闭塞(CTO)病变合并左心室射血分数(LVEF)降低患者术后1个月和1年的生活质量的影响。方法前瞻性连续性纳入2018年3月至2020年3月因冠心病诊断入院计划行冠状动脉造影的患者,术前48 h采用健康相关生命质量SF-12量表(SF-12)和西雅图心绞痛量表(SAQ)评价患者生活质量,同时收集记录患者临床基线资料。将造影诊断为CTO病变且成功行PCI的563例患者纳入本研究,依据术前LVEF,分为LVEF≥50%组(327例)和LVEF<50%组(236例)。术后1个月和1年分别对患者进行电话随访,记录患者主要不良心血管事件(MACE)的发生情况,同时采用SF-12和SAQ评价患者术后生活质量。结果术后1个月,LVEF<50%组患者MACE发生率与LVEF≥50%组比较,差异无统计学意义(P=0.223)。术后1年,LVEF<50%组患者MACE发生率显著高于LVEF≥50%组(22.5%比10.4%,P<0.001),差异有统计学意义。术后1个月和1年时,两组患者的纽约心脏病协会(NYNA)心功能都发生了明显改善(均P<0.001)。术后1个月、术后1年LVEF≥50%组患者分别与术前比较,SF-12的生理领域得分均显著升高(均P<0.001),SAQ 5个维度的得分均显著增加(均P<0.001);术后1个月、术后1年LVEF<50%组患者分别与术前比较,SF-12的生理领域得分均显著升高(均P<0.001),SAQ的5个维度的得分均显著增加(均P<0.001)。两组患者术后1个月、术后1年SF-12和SAQ的5个维度得分比较,差异均无统计学意义(均P>0.05)。结论成功PCI可以显著改善CTO病变合并LVEF降低患者术后1个月和1年的心功能和生活质量。

Objective To evaluate the effect of percutaneous coronary intervention(PCI)on quality of life of chronic total occlusion(CTO)patients with reduced left ventricular ejection fraction(LVEF)in one month and one year after procedure.Methods Patients consecutively admitted to the First Affiliated Hospital of PLA Air Force Military Medical University who underwent coronary angiography were prospectively enrolled,and their quality of life was evaluated by SF-12 and Seattle angina questionnaire(SAQ)questionnaires on 48 hours before PCI,and their clinical baseline data were also collected.A total of 563 patients with angiographic diagnosis of CTO and successful PCI were included in this study.According to preoperative LVEF,they were divided into LVEF≥50%group(n=327)and LVEF<50%group(n=236).Follow-up was conducted in one month and one year after PCI.Major adverse cardiovascular events(MACE)were recorded,and SF-12 and SAQ were used to evaluate the postoperative quality of life of the patients.Results One month after PCI,the incidence of MACE in the LVEF<50%group was similar to that in the LVEF≥50%group(P=0.223);one year after PCI,however,the incidence of MACE in LVEF<50%group was significantly higher than that in LVEF≥50%group(22.5%vs.10.4%,P<0.001).In addition,cardiac function and quality of life improved significantly in both groups at one month and one year after PCI(all P<0.001),and the degree of improvement was similar between the two groups(all P>0.05).Conclusions Successful PCI can significantly improve cardiac function and quality of life in patients with CTO and reduced LVEF one month and one year after PCI.