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目的探究LVEF>40%伴心衰的冠心病患者接受血运重建治疗的近期及远期预后。方法连续入选2003年7月1日至2005年9月30日在北京安贞医院接受经皮冠脉介入治疗(PCI)或冠脉旁路移植术(CABG)的3286例患者。至少随访1年,平均随访时间18个月。按照左室射血分数(LVEF)和有无充血性心力衰竭分为:A组LVEF>40%并无心衰者(2022例)、B组LVEF>40%伴心力衰竭者(1070例)、C组LVEF≤40%(194例)。比较各组患者间的临床特征、院内、长期死亡及主要不良心脑血管事件(MACCE)的发生率。结果 67.1%患者接受PCI治疗,32.9%患者接受CABG治疗,A组患者接受PCI治疗的比例最高。LVEF>40%的冠心病患者中伴有心衰的患者并不少见,占34.6%。LVEF≤40%组患者院内死亡率、长期死亡率明显高于其他两组患者。LVEF>40%伴心衰者组患者院内死亡率、长期死亡率明显高于LVEF>40%并无心衰者组患者。COX多因素回归分析结果显示,除LVEF≤40%组患者死亡风险是LVEF>40%并无心衰组患者的2.3倍(HR2.324,95%CI0.982～5.728),LVEF>40%伴心衰组患者死亡率是LVEF>40%无心衰组患者的1.3倍(HR1.275,95%CI0.792～2.053)。结论 LVEF>40%的冠心病患者中伴有心衰的患者并不少见死亡率高,是LVEF>40%无心衰组患者的1.3倍。
Objective To investigate the short-term and long-term prognosis of patients with coronary artery disease with LVEF> 40% heart failure undergoing revascularization. Methods A total of 3286 patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) were enrolled in the Anzhen Hospital of Beijing from July 1, 2003 to September 30, 2005. At least one year follow-up, with an average follow-up of 18 months. According to the left ventricular ejection fraction (LVEF) and congestive heart failure, the patients with LVEF> 40% had no heart failure (2022 cases) in group A, 1070 cases with LVEF> 40% Group C LVEF ≤ 40% (194 cases). The clinical characteristics, hospital-based, long-term mortality and the incidence of major adverse cardiovascular events (MACCE) were compared among the groups. Results 67.1% patients underwent PCI, 32.9% received CABG, and patients in Group A received the highest proportion of PCI. Patients with LVEF> 40% of patients with coronary heart disease are not uncommon, accounting for 34.6%. In-hospital mortality and long-term mortality in patients with LVEF ≤40% were significantly higher than those in the other two groups. In-hospital mortality and long-term mortality in patients with LVEF> 40% heart failure were significantly higher than those in patients with LVEF> 40% without heart failure. COX multivariate regression analysis showed that the risk of death in patients with LVEF ≤40% was 2.3 times (HR 2.324, 95% CI 0.982 to 5.728) and LVEF> 40% with LVEF> 40% and no heart failure Mortality in patients with heart failure was 1.3-fold (HR 1.275, 95% CI, 0.792 to 2.053) in patients with LVEF> 40% without heart failure. Conclusions Patients with heart failure in LVEF> 40% of patients with coronary heart disease are not uncommon with high mortality, 1.3 times more likely than those with LVEF> 40% without heart failure.