成功经皮冠状动脉介入术显著改善慢性完全闭塞病变合并左心室射血分数降低的冠心病患者生活质量  

Successful percutaneous coronary intervention improves quality of life in chronic total occlusion patients with low left ventricular ejection fraction

作　　者：赵帅 孙盼盼 王刚 杨易 朱惠莉 周健 汪雅莉 朱伯达 陈焱 禹天同 王嘉仪 高好考 廉坤 李成祥 ZHAO Shuai;SUN Pan-pan;WANG Gang;YANG Yi;ZHU Hui-li;ZHOU Jian;WANG Ya-li;ZHU Boda;CHEN Yan;YU Tian-tong;WANG Jia-yi;GAO Hao-kao;LIAN Kun;LI Cheng-xiang(Department of Cardiology,Air Force Hospital,Western Theater Command,Chengdu 610000,Sichuan,China;Primary Flight Training Base,Air Force Aviation University,Haerbin 150100,Heilongjiang China;Department of Cardiology,PLA 971 Naval Hospital,Qingdao 266071,Shandong,China;Department of Cardiology,Xijing Hospital,chool of Basic Medical Sciences,Air Force Medical University,Xi’an 710032,Shaanxi,China;Cadet Brigade,School of Basic Medical Sciences,Air Force Medical University,Xi’an 710032,Shaanxi,China)

机构地区：[1]西部战区空军医院心血管内科,四川成都610000 [2]空军航空大学初级飞行训练基地,黑龙江哈尔滨150100 [3]中国人民解放军海军第九七一医院心血管内科,山东青岛266071 [4]空军军医大学第一附属医院心血管内科,陕西西安710032 [5]空军军医大学基础医学院学员三大队,陕西西安710032

出　　处：《心脏杂志》2025年第1期24-29,共6页Chinese Heart Journal

基　　金：西京医院医务人员培养助推项目(XJZT24LY39);空军军医大学临床研究项目(2022LC2208);青岛市医药卫生科研指导项目(2023-WJZD244);雅培心血管项目(COR-10538);苏可安药业公司项目(SKA-2023010)。

摘　　要：目的对于慢性完全闭塞病变(CTO)合并左心室射血分数(LVEF)降低的冠心病患者,评估成功的经皮冠状动脉介入术(PCI)能否改善其生活质量。方法前瞻性连续性纳入2018年4月~2022年5月在空军军医大学第一附属医院接受PCI的CTO患者,并将其分为LVEF≥50%(A组,n=889)、50%>LVEF>35%(B组,n=353)和LVEF≤35%(C组,n=170)3组。收集患者术前基线资料,采用SF-12量表和EQ-5D量表评估患者生活质量,收集手术资料以及1月和1年对患者进行随访。结果与LVEF≥50%组(A组)相比,在50%>LVEF>35%组(B组)和LVEF≤35%组(C组)中:C组年龄增加(P<0.01)、C组高血压比例低(P<0.05)、B组和C组既往心梗史比例高(均P<0.01),B组冠脉搭桥术比例高(P<0.05)、B组和C组空腹血糖高(均P<0.05)、B组血肌酐高(P<0.01)、B组和C组eGFR低(均P<0.01)。与50%>LVEF>35%组相比,LVEF≤35%组年龄增加(P<0.01)、收缩压降低(P<0.01)、高血压病史比例低(P<0.05)、左主干病变比例高(B组P<0.05,C组P<0.01)、C组左前降支病变比例高(P<0.05)、B组和C组左回旋支病变比例高(均P<0.01)、B组和C组多支病变比例高(均P<0.01)。在1月随访时,三组患者分别有810例(98.06%)、316例(97.23%)和144例(96.64%)完成随访,在1年随访时,分别有752例(91.04%)、293例(90.15%)和139例(93.29%)患者完成随访。与术前相比,三组患者术后1月和1年时SF-12量表PCS维度和EQ-5D量表评分显著升高(均P<0.01),三组间术后1月随访及1年随访数据无统计学差异。说明术后1月和1年随访时CTO合并LVEF≤35%的患者生活质量显著改善(P<0.01),且其改善程度与其他两组相似。结论成功PCI显著改善CTO合并LVEF降低的冠心病患者生活质量。AIM To assess whether successful percutaneous coronary intervention(PCI)could improve the quality of life in chronic total occlusion(CTO)patients with low left ventricular ejection fraction(LVEF,≤35%).METHODS CTO patients who underwent PCI in the First Affiliated Hospital of Air Force Medical University from April 2018 to May 2022 were prospectively and consecutively enrolled and subdivided into 3 groups:LVEF≥50%,50%>LVEF>35%and LVEF≤35%.Their detailed baseline data were collected,quality of life was assessed respectively using the SF-12 and EQ-5D quality of life questionnaire,and surgical details and 1 month and 1 year follow-up data were also collected.RESULTS Totally 1412 CTO patients were successfully enrolled.LVEF≤35%was present in 170 patients(12.04%),who were elder in age,had more previous MI,higher total cholesterol and LDL-C level,lower eGFR and CrCL level,and higher proportions of NYHA functional class III/IV,multivessel disease,multi-CTO lesion and calcification(P<0.05).One month and 1 year follow-up found that the quality of life of CTO patients was markedly improved(P<0.05),notably at a similar degree between patients with LVEF≤35%and the other two groups(P>0.05).CONCLUSION Successful PCI significantly improves the quality of life in CTO patients with low LVEF.

关 键 词：慢性完全闭塞病变 左室射血分数 经皮冠状动脉介入术 生活质量 

分 类 号：R541.4[医药卫生—心血管疾病]