Department of Atherosclerosis, Heart Institute of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo/SP 05403-000, Brazil.
Eur Heart J. 2013 Nov;34(43):3370-7. doi: 10.1093/eurheartj/eht201. Epub 2013 Jul 4.
Assuming that coronary interventions, both coronary bypass surgery (CABG) and percutaneous coronary intervention (PCI), are directed to preserve left ventricular function, it is not known whether medical therapy alone (MT) can achieve this protection. Thus, we evaluated the evolution of LV ejection fraction (LVEF) in patients with stable coronary artery disease (CAD) treated by CABG, PCI, or MT as a post hoc analysis of a randomized controlled trial with a follow-up of 10 years.
Left ventricle ejection fraction was assessed with transthoracic echocardiography in patients with multivessel CAD, participants of the MASS II trial before randomization to CABG, PCI, or MT, and re-evaluated after 10 years of follow-up.
Of the 611 patients, 422 were alive after 10.32 ± 1.43 years. Three hundred and fifty had LVEF reassessed: 108 patients from MT, 111 from CABG, and 131 from PCI. There was no difference in LVEF at the beginning (0.61 ± 0.07, 0.61 ± 0.08, 0.61 ± 0.09, respectively, for PCI, CABG, and MT, P = 0.675) or at the end of follow-up (0.56 ± 0.11, 0.55 ± 0.11, 0.55 ± 0.12, P = 0.675), or in the decline of LVEF (reduction delta of -7.2 ± 17.13, -9.08 ± 18.77, and -7.54 ± 22.74). Acute myocardial infarction (AMI) during the follow-up was associated with greater reduction in LVEF. The presence of previous AMI (OR: 2.50, 95% CI: 1.40-4.45; P = 0.0007) and during the follow-up (OR: 2.73, 95% CI: 1.25-5.92; P = 0.005) was associated with development of LVEF <45%.
Regardless of the therapeutic option applied, LVEF remains preserved in the absence of a major adverse cardiac event after 10 years of follow-up.
http://www.controlled-trials.com. Registration number ISRCTN66068876.
假设冠状动脉介入治疗（包括冠状动脉旁路移植术[CABG]和经皮冠状动脉介入治疗[PCI]）的目的是保留左心室功能，那么单独采用药物治疗（MT）是否可以实现这一目标尚不清楚。因此，我们对多支血管病变的患者进行了一项回顾性分析，这些患者来自于一项随机对照试验（MASS II 试验），在接受 CABG、PCI 或 MT 治疗后，对左心室射血分数（LVEF）进行了 10 年的随访。
采用经胸超声心动图评估多支血管病变患者的左心室射血分数，这些患者为 MASS II 试验的参与者，在随机分组至 CABG、PCI 或 MT 之前进行评估，并在 10 年随访后再次进行评估。
611 例患者中，有 422 例在 10.32 ± 1.43 年后存活。350 例接受了 LVEF 重新评估：108 例来自 MT 组，111 例来自 CABG 组，131 例来自 PCI 组。在开始时（分别为 PCI、CABG 和 MT 组的 0.61 ± 0.07、0.61 ± 0.08 和 0.61 ± 0.09，P = 0.675）或在随访结束时（0.56 ± 0.11、0.55 ± 0.11 和 0.55 ± 0.12，P = 0.675），或在 LVEF 下降方面（减少的差值为-7.2 ± 17.13、-9.08 ± 18.77 和-7.54 ± 22.74），LVEF 没有差异。随访期间发生急性心肌梗死（AMI）与 LVEF 下降幅度更大有关。随访期间存在既往 AMI（比值比：2.50，95%置信区间：1.40-4.45；P = 0.0007）和 AMI（比值比：2.73，95%置信区间：1.25-5.92；P = 0.005）与 LVEF <45%的发生相关。
在没有发生重大不良心脏事件的情况下，无论采用何种治疗选择，10 年后 LVEF 仍保持不变。
http://www.controlled-trials.com。注册号 ISRCTN66068876。
