血运重建对糖尿病合并心力衰竭的冠状动脉慢性完全闭塞病变的临床效果分析  

The clinical effect of revascularization on chronic complete occlusion of coronary artery in diabetic patients with heart failure

作　　者：冯婷婷 闫云峰 杨丽睿 赵林[1] Feng Tingting;Yan Yunfeng;Yang Lirui;Zhao Lin(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]北京市心肺血管疾病研究所、首都医科大学附属北京安贞医院心脏内科,北京100029

出　　处：《中华胸心血管外科杂志》2024年第4期207-213,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(82370412)。

摘　　要：目的探讨冠状动脉慢性完全闭塞(CTO)病变的血运重建是否对糖尿病合并心力衰竭(HF)患者有益。方法回顾性连续纳入糖尿病合并HF的稳定型CTO患者。根据CTO血管的治疗策略,将患者分为成功血运重建(CTO-SR)组和药物治疗(CTO-MT)组。主要终点是主要不良心脏事件(MACE)。根据左心室射血分数(LVEF)进行亚组分析。结果共680例患者入选,CTO-MT组344例,CTO-SR组336例。中位随访34个月后,CTO-SR组的MACE发生率显著低于CTO-MT组(调整HR=0.462,95%CI:0.337~0.634)。倾向性评分匹配分析也证实了CTO-SR组的优越性(HR=0.494,95%CI:0.337~0.725)。亚组分析进一步证实了LVEF≥0.4的患者中,CTO-SR具有一致的优越性,而在LVEF<0.4的患者中则未表现出优越性。结论对于糖尿病合并HF的稳定型CTO患者,CTO-SR优于CTO-MT。CTO-SR的优势在LVEF≥0.4的患者中是一致的,但在LVEF<0.4的患者则不一致。Objective To explore whether the revascularization of chronic total occlusion(CTO)is beneficial to patients with heart failure(HF)in diabetes.Methods In this retrospective cohort study,diabetic HF patients with stable CTO were consecutively enrolled.Based on treatment strategies to the CTO vessel,patients were assigned to successful revascularization(CTO-SR)or medical therapy(CTO-MT)group.The primary endpoints were major adverse cardiac events(MACE).Subgroup analysis were performed based on left ventricular ejection fraction(LVEF).Results A population of 680 patients were enrolled:344 patients in the CTO-MT group,and 336 patients in the CTO-SR group.After a median follow-up of 34 months,CTO-SR was superior to CTO-MT in MACE(HR=0.462,95%CI:0.337-0.634),which could mainly due to the superiority in cardiac-death and target-vessel-revascularization.Propensity matching analysis also confirmed CTO-SR’s superiority(HR=0.494,95%CI:0.337-0.725).Subgroup analysis further confirmed a consistent superiority in patients with LVEF≥0.4,but not in those with LVEF<0.4.Conclusion Thus,we concluded that for patients with diabetes,HF and stable CTO,CTO-SR was superior to CTO-MT.CTO-SR’s superiority was consistent in patients with LVEF≥0.4,but not for patients with LVEF<0.4.

关 键 词：慢性完全闭塞 糖尿病 血运重建 药物治疗 心力衰竭 

分 类 号：R587.2[医药卫生—内分泌] R541.6[医药卫生—内科学]