衰弱状态与老年冠心病患者PCI术后心功能及其预后

Correlation between the frailty status and myocardial injury in elderly patients with coronary heart disease after percutaneous coronary intervention

目的分析老年冠心病患者经皮冠脉介入治疗(PCI)后的衰弱状态与心肌损伤、心脏结构功能的关系,并评估其对长期预后的价值。方法纳入2020年1月至2022年1月在安徽省池州市人民医院行PCI的老年冠心病患者348例。术后通过改良Tilburg衰弱量表进行评估,将总分≥5分的患者设置为衰弱组(n=152),其他患者为非衰弱组(n=196)。比较两组患者手术前后的心肌损伤标志物[B型利钠肽(BNP)、心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)]和心功能指标[左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、左心室后壁厚度(LVPW)、左心室射血分数(LVEF)]。随访2年,对比两组发生心血管不良事件的情况(心源性休克、心源性死亡、严重心力衰竭、急性心肌梗死)。通过Pearson相关性分析患者心肌损伤及心脏结构功能与衰弱状态的关系,ROC曲线评估Tilburg评分对患者预后情况的诊断效能。结果术后非衰弱组心肌损伤标志物水平、LVESD、LVEDD低于衰弱组,LVEF高于衰弱组(均P<0.05)。Tilburg评分与心肌损伤情况、LVESD、LVEDD呈正相关,与LVEF呈负相关;且Tilburg评分对患者预后评估的ROC曲线下面积为0.982。结论老年冠心病患者PCI术后衰弱状态与心肌损伤及心脏结构功能有显著的相关性,对长期预后有较高的预测价值。

Objective To analyze the relationship of frailty status to myocardial injury and cardiac structure function in elderly patients with coronary heart disease after receiving percutaneous coronary intervention(PCI),and to assess its value in predicting long-term outcomes.Methods A total of 348 elderly patients with coronary heart disease,who underwent PCI at the Chizhou Municipal People's Hospital of China from January 2020 to January 2022,were enrolled in this study.After PCI,the modified Tilburg Frailty scale was used to assess the patient's frailty status,based on which the patients were divided into frailty group(total score being≥5 points,n=152)and non-frailty group(total score being<5 points,n=196).Both the preoperative and postoperative levels of myocardial injury biomarkers,including brain natriuretic peptide(BNP),cardiac troponin T(cTnT)and creatine kinase isozyme(CKMB),and cardiac function indexes,including left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),left ventricular posterior wall thickness(LVPW),and left ventricular ejection fraction(LVEF),were compared between the two groups.All the patients were followed up for two years.The incidence of cardiovascular adverse events,including cardiogenic shock,cardiac death,severe heart failure,and acute myocardial infarction was compared between the two groups.Pearson correlation analysis was used to explore the relationship of frailty status to myocardial injury and cardiac structure function.ROC curve was used to evaluate Tilburg Frailty scale score in predicting longterm effect.Results In the non-frailty group,the postoperative levels of myocardial injury biomarkers,LVESD and LVEDD were lower than those in the frailty group,while LVEF was higher than that in the frailty group(all P<0.05).A positive correlation existed between Tilburg Frailty scale score and myocardial injury,LVESD,LVEDD,while a negative correlation existed between Tilburg Frailty scale score and LVEF,and the area under the ROC curve of Tilburg score for assessing the patient prognosis was O.982.Conclusion In elderly patients with coronary heart disease after receiving PCI,the post-PCI frailty status is closely correlated with the myocardial injury and cardiac structure function,which has a high value for predicting the long-term prognosis of the patients.