冠心病合并射血分数降低患者血运重建策略:经皮冠状动脉介入治疗和冠状动脉旁路移植术的对比研究  

Percutaneous coronary intervention versus coronary artery bypass grafting surgery in patients with coronary artery disease and reduced ejection fraction

作　　者：王韶屏[1] 刘严慈 吴铮[1] 郑泽[1] 彭红玉[1] 赵东晖[1] 李芳[1] 程姝娟[1] 柳景华[1] WANG Shao-ping;LIU Yan-ci;WU Zheng;ZHENG Ze;PENG Hong-yu;ZHAO Dong-hui;LI Fang;CHENG Shu-juan;LIU Jing-hua(Center for Coronary Artery Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院冠心病中心,北京100029

出　　处：《中国介入心脏病学杂志》2023年第11期828-834,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的对比经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)治疗冠状动脉粥样硬化性心脏病(CAD)合并左心室收缩功能不全患者的血运重建效果。方法研究纳入2005年1月1日至2014年12月31日首都医科大学附属北京安贞医院905例CAD合并左心室射血分数(LVEF)降低(≤35%)的患者。对比PCI和CABG治疗后患者的短期和长期全因死亡率、因心力衰竭再入院发生率和再次血运重建率。采用倾向性评分匹配两组患者基线资料。结果与CABG组相比,PCI组患者术后30 d死亡率更低(HR 0.29,95%CI 0.09~0.88,P=0.029)。平均随访4.5年结果发现,PCI与CABG的全因死亡率(HR 1.00,95%CI 0.67~1.50,P=0.990)以及因心力衰竭再入院发生率(HR 0.81,95%CI 0.40~1.64,P=0.561)差异均无统计学意义。PCI组患者再次血运重建发生率更高(HR 14.46,95%CI 3.43~60.98,P<0.001),差异有统计学意义。与CABG比,PCI能更显著地改善患者心功能(交互作用P=0.031)。结论在CAD合并LVEF降低患者中,与CABG相比,PCI有着更低的短期死亡率,同时心功能改善更显著,但再次血运重建发生率更高。PCI与CABG的长期生存率以及因心力衰竭再入院风险相似。Objective Current data are insufficient for comparisons of effectiveness between percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)among patients with coronary artery disease(CAD)and left ventricular dysfunction.Methods A total of 905 CAD patients with reduced left ventricular ejection fraction(LVEF≤35%)in single center of China who underwent either PCI or CABG were enrolled in a real-world cohort study.Clinical outcomes included short-and long-term all�cause mortality,rates of heart failure(HF)hospitalization and repeat revascularization.Propensity score matching was used to balance the 2 cohorts.Results PCI was associated with lower 30-day mortality rate(HR 0.29,95%CI 0.09–0.88,P=0.029).At a mean follow�up of 4.5 years,PCI and CABG had similar all-cause death(HR 1.00,95%CI 0.67–1.50,P=0.990)and HF hospitalization(HR 0.81,95%CI 0.40–1.64,P=0.561),but PCI had higher risk of repeat revascularization(HR 14.46,95%CI 3.43–60.98,P<0.001).PCI was associated with more significant LVEF improvement than CABG(P=0.031 for interaction).Conclusions CAD patients with reduced LVEF who underwent PCI had lower short-term mortality rate and more LVEF improvement but higher risk of repeat revascularization during follow-up than patients who underwent CABG.PCI showed comparable long-term survival and HF hospitalization risk.

关 键 词：冠状动脉旁路移植术 左心室射血分数 心力衰竭 血运重建 支架 

分 类 号：R54[医药卫生—心血管疾病]