1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Kardiol Pol. 2018;76(1):144-152. doi: 10.5603/KP.a2017.0181. Epub 2017 Oct 5.
Coronary revascularization is common in heart failure (HF).
Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG).
The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated.
PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients.
The revascularized HF patients had a similar mortality and higher risk of death or hospitalizationsat 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.
冠状动脉血运重建在心力衰竭（HF）中很常见。
评估因 HF 住院且既往接受过经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）或未接受过 PCI 或 CABG 的患者的住院期间和长期结局的临床特征和评估。
ESC-HF Pilot 调查中的 649 名住院患者在一年时评估主要终点（PE）（全因死亡）和次要终点（SE）（全因死亡或因 HF 恶化而住院）。此外，评估指数住院期间的死亡发生情况。
PCI/CABG 患者（32.7%）更常为男性、吸烟者、患有心肌梗死、高血压（HT）、外周动脉疾病和糖尿病。而非 PCI/CABG 患者更常发生心源性休克并在院内死亡。PE 发生在 212 例 PCI/CABG 患者中的 33 例（15.6%）和 437 例非 PCI/CABG 患者中的 56 例（12.8%；P=0.3）。SE 发生在 170 例 PCI/CABG 患者中的 82 例（48.2%）和 346 例非 PCI/CABG 患者中的 122 例（35.3%；P=0.01）。PCI/CABG 患者中 PE 的独立预测因素为：左心室射血分数较低、使用抗血小板药物；而非 PCI/CABG 患者中 PE 的独立预测因素为：年龄、入院时的急性冠状动脉综合征（ACS）。PCI/CABG 患者中 SE 的独立预测因素为：糖尿病、入院时的纽约心脏协会（NYHA）心功能分级、HT；而非 PCI/CABG 患者中 SE 的独立预测因素为：NYHA 心功能分级、入院时的血红蛋白。入院时血清钠浓度是两组患者 PE 和 SE 的预测因素。非 PCI/CABG 患者出院时的心率是 PE 和 SE 的预测因素。
与非 PCI/CABG 患者相比，血运重建的 HF 患者在 12 个月时的死亡率相似，但死亡或住院风险更高。血运重建患者合并症更多，而非 PCI/CABG 患者心源性休克和院内死亡率更高。
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