| 左心功能受损的急性冠脉综合征患者首次PCI干预后心功能变化对预后的影响 |
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| 引用本文： | 吴德喜,宋兴隆,闫浩东,张学斌,孙冬冬,郭文怡. 左心功能受损的急性冠脉综合征患者首次PCI干预后心功能变化对预后的影响[J]. 心脏杂志, 2023, 35(2): 141-145+155. DOI: 10.12125/j.chj.202206084 |
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| 作者姓名： | 吴德喜 宋兴隆 闫浩东 张学斌 孙冬冬 郭文怡 |
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| 作者单位： | 空军军医大学西京医院心内科, 陕西 西安710032 |
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| 摘 要： | 目的 旨在探讨对于左心功能受损（LVEF≤50%）的急性冠脉综合征（ACS）患者,首次PCI干预后心功能早期变化与长期预后的关系。方法 连续录入2010年1月～2015年12月就诊于西京医院心内科,并成功行首次经皮冠脉介入（PCI）治疗的左心功能受损的ACS患者,收集其术前、术后3个月、6个月与12个月超声心动图左室射血分数值（LVEF）。根据早期LVEF的变化（3个月LVEF值与基线的差值）情况将患者分为3组：未恢复组（ΔLVEF≤0）,轻度升高组（0<ΔLVEF≤14）和明显升高组（ΔLVEF>14）。研究主要终点为主要不良心脑血管事件（MACCE）,包括全因死亡、再次血运重建、脑卒中等。用COX多因素回归分析心功能早期变化与长期预后的关系。结果 三组之间两两比较,基线LVEF和3个月时的LVEF差异均有统计学意义（均P<0.01）。全因死亡率三组之间无统计学差异,全因再入院率未恢复组与轻度升高组明显高于升高组（P<0.01）,全因再入院率中再次血运重建三组间无统计学差异,脑卒中与症状复发再入院率有统计学差异。与未恢复组相比,轻度升高组和明显升高组发生MAC...
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| 关 键 词： | 急性冠脉综合征 经皮冠状动脉介入 早期射血分数变化 主要不良心脑血管事件 |
| 收稿时间： | 2022-06-28 |
Influence of early left ventricular ejection fraction change on prognosis after initial PCI intervention in patients with acute coronary syndrome with impaired left ventricular ejection fraction |
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| Affiliation: | Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi, China |
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| Abstract: | AIM To find out the relationship between early change of left ventricular ejection fraction (ΔLVEF) and long-term prognosis after initial percutaneous coronary intervention (PCI) intervention in patients with acute coronary syndrome (ACS) with impaired left ventricular ejection fraction (LVEF ≤50%) at admission. METHODS Patients with ACS and impaired LVEF who were admitted to the Cardiology Department of Xijing Hospital for the first time and successfully underwent PCI from January 2010 to December 2015 were enrolled. LVEF value was collected before, 3 months, 6 months and 12 months after PCI. The early change of LVEF (ΔLVEF) was defined as the difference between 3-month LVEF and the baseline LVEF and the patients were stratified into three categories: nonrecovery group (ΔLVEF≤0), slightly increase group (0<ΔLVEF≤14) and significantly increase group (ΔLVEF>14). The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) and the relationship between early change of LVEF and MACCE was assessed in Cox multivariable models. RESULTS There were significant differences in LVEF at baseline and 3 months among the three groups (all P<0.01). There was no statistical difference among the three groups in the all-cause mortality rate. The all-cause readmission rate in the nonrecovery group and the slightly increased group was higher than that in the significantly increased group. Compared with the non recovery group, the risk of MACCE in the slightly elevated group and the significantly elevated group decreased by 33% (HR=0.67, 95% CI: 0.51～0.88, P<0.01) and 57% (HR=0.43, 95% CI: 0.29～0.64, P<0.01), respectively. After multifactorial adjustment, age, cardiac function grade (3-4), hypertension, previous stroke history, low-density lipoprotein cholesterol, γ-Glutamyltransferase (GGT) and right coronal lesion are risk factors for predicting major adverse cardiovascular and cerebrovascular events, while early cardiac function changes (ΔLVEF) is a protective factor. CONCLUSION The extent of early LVEF change has important prognostic value in ACS patients with impaired LVEF (≤50%) after primary PCI. Therefore, health education and early follow-up are important for these patients and so is the control of LDL and blood pressure and the monitoring of GGT. |
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