Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2012 Feb 1;109(3):344-51. doi: 10.1016/j.amjcard.2011.09.016. Epub 2011 Nov 22.
Ischemic cardiomyopathy with depressed left ventricular ejection fraction (LVEF) is predictive of death after percutaneous coronary intervention (PCI), but its association with stent thrombosis (ST) and the need for repeat revascularization is less clearly defined. In total 5,377 patients undergoing PCI were retrospectively evaluated. Multivariable Cox proportional hazards regression and competitive outcome analysis were employed. The primary end point was 1-year major adverse cardiac events (all-cause death, Q-wave myocardial infarction, ST, and target lesion revascularization [TLR]). Individual end points of ST and of TLR were also evaluated. Patients with normal LVEF (>50%) were compared to those with mild (41% to 50%), moderate (25% to 40%), and severe (<25%) decreases in LVEF. Patients with abnormal LVEF were older and more commonly diabetic and had renal insufficiency and heart failure syndrome (p <0.001 for all variables). These patients demonstrated more angiographically complex lesions and less frequently received a drug-eluting stent. The primary end point was significantly increased in patients with lower LVEF (9.7% for normal LVEF vs 20.6% for severely decreased LVEF, p <0.001). ST occurred more frequently in these patients (1.4% for normal LVEF vs 6% for severely decreased LVEF, p <0.001), but clinically driven TLR did not significantly change across LVEF categories. After adjustment, only moderate and severe LVEF decreases (i.e., LVEF ≤40%) demonstrated an association with major adverse cardiac events and with the individual outcome of ST. Subgroup analysis of patients receiving only a drug-eluting stent or a bare-metal stent demonstrated no statistically significant differences for the probability of ST. In conclusion, decreased LVEF is not associated with clinically driven TLR but does increase the risk of ST. Patients with LVEF ≤40% appear to be at significantly higher risk for ST and therefore might benefit from interventional and pharmacologic strategies aimed at minimizing this risk.
缺血性心肌病伴左心室射血分数（LVEF）降低（LVEF 降低）可预测经皮冠状动脉介入治疗（PCI）后的死亡，但与支架血栓形成（ST）和再血运重建的关系尚不清楚。共回顾性评估了 5377 例接受 PCI 的患者。采用多变量 Cox 比例风险回归和竞争结果分析。主要终点是 1 年主要不良心脏事件（全因死亡、Q 波心肌梗死、ST 和靶病变血运重建[TLR]）。还评估了 ST 和 TLR 的个别终点。将 LVEF 正常（>50%）的患者与 LVEF 轻度降低（41%至 50%）、中度降低（25%至 40%）和重度降低（<25%）的患者进行比较。LVEF 异常的患者年龄较大，更常见糖尿病，且肾功能不全和心力衰竭综合征（所有变量 p<0.001）。这些患者表现出更复杂的血管造影病变，较少接受药物洗脱支架治疗。LVEF 较低的患者主要终点明显增加（LVEF 正常的患者为 9.7%，而 LVEF 严重降低的患者为 20.6%，p<0.001）。这些患者 ST 发生更频繁（LVEF 正常的患者为 1.4%，而 LVEF 严重降低的患者为 6%，p<0.001），但根据 LVEF 分类，临床驱动的 TLR 并未显著改变。调整后，仅中度和重度 LVEF 降低（即 LVEF ≤40%）与主要不良心脏事件和 ST 的个别结局相关。仅接受药物洗脱支架或裸金属支架治疗的患者亚组分析显示，ST 的概率无统计学差异。总之，LVEF 降低与临床驱动的 TLR 无关，但会增加 ST 的风险。LVEF≤40%的患者发生 ST 的风险明显更高，因此可能受益于旨在最大程度降低这种风险的介入和药物策略。
