Raposo Luís, Aguiar Carlos, Ferreira Jorge, de Gonçalves Pedro Araújo, Ferreira António, da Silva José Aniceto
Servçgo de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal.
Rev Port Cardiol. 2010 Jul-Aug;29(7-8):1131-42.
Congestive heart failure (CHF) has a strong negative prognostic impact in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). The purpose of this study was to establish the effect of myocardial revascularization on prognosis in this setting.
We retrospectively studied 648 patients admitted with NSTE-ACS and not presenting cardiogenic shock. The effect of coronary revascularization on the outcome of patients with and without CHF was assessed using a propensity score-adjusted regression model.
Congestive heart failure was present in 89 patients (14.5%) on hospital admission. During the index hospitalization, 426 patients received myocardial revascularization, through percutaneous coronary intervention (PCI) in 321 cases, and coronary artery bypass grafting (CABG) in 105. In a 6-month follow-up, 38 patients (6.2%) died and 42 (6.8%) experienced non-fatal myocardial infarction (MI). CHF was an independent predictor of both 6-month mortality (adjusted HR 3.6; 95% CI 1.86-6.95; p < 0.001) and 6-month death/(re-)MI (adjusted HR 2.1; 95% CI 1.3-3.5; p = 0.003). Revascularization significantly influenced the prognosis of patients presenting CHF (adjusted HR 0.31; 95% CI 0.13-0.73; p = 0.008), but not of those without CHF (adjusted HR 1.37; 95% CI 0.65-2.89; p = 0.4). A significant interaction was found between revascularization and the prognostic impact of CHF at admission (p = 0.021 for the interaction).
In patients with NSTE-ACS, clinical manifestations of CHF constitute a strong predictor of adverse medium-term outcome that may be significantly modified by myocardial revascularization.
充血性心力衰竭（CHF）对非ST段抬高型急性冠脉综合征（NSTE-ACS）患者的预后有强烈的负面影响。本研究的目的是确定在这种情况下心肌血运重建对预后的影响。
我们回顾性研究了648例因NSTE-ACS入院且未出现心源性休克的患者。使用倾向评分调整回归模型评估冠状动脉血运重建对有和无CHF患者结局的影响。
89例（14.5%）患者入院时存在充血性心力衰竭。在本次住院期间，426例患者接受了心肌血运重建，其中321例通过经皮冠状动脉介入治疗（PCI），105例通过冠状动脉旁路移植术（CABG）。在6个月的随访中，38例（6.2%）患者死亡，42例（6.8%）发生非致命性心肌梗死（MI）。CHF是6个月死亡率（校正HR 3.6；95%CI 1.86-6.95；p<0.001）和6个月死亡/（再）MI（校正HR 2.1；95%CI 1.3-3.5；p=0.003）的独立预测因素。血运重建显著影响CHF患者的预后（校正HR 0.31；95%CI 0.13-0.73；p=0.008），但对无CHF患者的预后无影响（校正HR 1.37；95%CI 0.65-2.89；p=0.4）。发现血运重建与入院时CHF的预后影响之间存在显著交互作用（交互作用p=0.021）。
在NSTE-ACS患者中，CHF的临床表现是中期不良结局的有力预测因素，心肌血运重建可能会显著改变这一结局。
