冠状动脉介入治疗对不稳定型心绞痛患者心功能和中长期预后的影响  

Impact of percutaneous coronary intervention on heart function and middle-and long-term outcome in patients with unstable angina

作　　者：李琪[1] 王伟民[1] 刘健[1] 曹成富[1] 宋俊贤[1] 张静[1] 马玉良[1] 赵红[1] 卢明瑜[1] 侯昌 LI Qi;WANG Wei-min;LIU Jian;CAO Cheng-fu;SONG Jun-xian;ZHANG Jing;MA Yu-liang;ZHAO Hong;LU Ming-yu;HOU Chang(Department of Cardiovascular Disease,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院心内科,北京100044

出　　处：《中国介入心脏病学杂志》2022年第9期672-676,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨对不稳定型心绞痛患者采用完全血运重建对其心功能和中长期预后的影响。方法连续纳入2019年1—12月于北京大学人民医院心内科行经皮冠状动脉介入治疗(PCI),诊断为不稳定型心绞痛并进行6个月以上的临床随访和超声心动图随访的患者276例。根据冠状动脉造影、腔内影像学和血流储备分数(FFR)结果判断冠状动脉病变是否为有血运重建意义的病变,对所有有血运重建意义的病变进行介入治疗分入完全血运重建组共202例,未对所有有血运重建意义的病变进行介入治疗分入非完全血运重建组共74例。比较两组患者的临床资料、病变特点、手术情况、左心室射血分数(LVEF)恶化率、不良心血管事件发生率等情况。结果完全血运重建组与非完全血运重建组患者多支病变比例(51.5%比94.6%,P<0.001)及使用腔内影像学指导PCI比例(16.3%比6.8%,P=0.041)比较,差异均有统计学意义。完全血运重建组与非完全血运重建组患者在随访期间出现LVEF恶化率(0.5%比6.8%,P=0.001)、再次血运重建率(9.4%比24.3%,P=0.013)、再发心肌梗死发生率(1.5%比12.2%,P=0.001)、心力衰竭恶化住院率(5.4%比28.4%,P<0.001)及总不良事件发生率(14.4%比43.2%,P<0.001)比较,差异均有统计学意义。两组中各发生1例心原性死亡,差异无统计学意义(P=0.548)。多因素Cox回归分析发现,平均每例置入支架数(OR 1.572,95%CI 1.152~2.960,P=0.047)、完全血运重建(OR 10.314,95%CI 1.011~20.662,P=0.012)是LVEF恶化的独立相关因素。结论完全血运重建可改善不稳定型心绞痛患者的中长期的心功能,并能减少不良心血管事件。Objective To evaluate the impact of complete or incomplete revascularization by percutaneous coronary intervention(PCI)on heart function and middle-and long-term outcome in unstable angina patients.Methods This study retrospectively included 276 unstable angina patients who underwent PCI and echocardiography from January 2019 to December 2019 in Peking University People’s Hospital.The patients received at least 6 months of clinical follow-up and echocardiography examination.The patients were divided into two groups according to completeness of revascularization:complete revascularization group included 202 patients and incomplete revascularization group included 74 patients.Baseline clinical features,lesion characteristics,operation data,heart function,echocardiography data and major adverse cardiovascular events were compared between the two groups.Results The proportion of patients with multivessel disease in the complete revascularization group and the incomplete revascularization group(51.5%vs.94.6%,P<0.001),using intraluminal imaging to guide PCI(16.3%vs.6.8%,P=0.041),the diff erence was all statistically signifi cant.During clinical follow-up,patients in the complete revascularization group and the incomplete revascularization group experienced worsening LVEF(0.5%vs.6.8%,P=0.001),repeat revascularization(9.4%vs.24.3%,P=0.013),recurrent myocardial infarction(1.5%vs.12.2%,P=0.001),hospitalization for worsening heart failure(5.4%vs.28.4%,P<0.001),and total adverse events(14.4%vs.43.2%,P<0.001).There was 1 cardiac death in each group without significant difference(P=0.548).After multivariate Cox regression analysis,it was found that the mean number of stents per case and complete revascularization were independent factors of worsening LVEF(OR 1.572,95%CI 1.152–2.960,P=0.047;OR 10.314,95%CI 1.011–20.662,P=0.012).Conclusions Complete revascularization can improve mid-and long-term cardiac function and reduce adverse cardiovascular events in patients with unstable angina pectoris.

关 键 词：不稳定型心绞痛 心功能 经皮冠状动脉介入治疗 完全血运重建 不完全血运重建 

分 类 号：R541[医药卫生—心血管疾病]