Wang Zongtao, Jin Lijun, Zhou Wanxing, Lei Da, Yan Hong, Yu Huimin, Zeng Zhihuan, Zhu Guiping, Zheng Jianyi, Dai Yining, Wang Haifang
The First Affiliated Hospital of Guangdong Pharmaceutical University, School of Clinical Medicine of Guangdong Pharmaceutical University Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science Nanfang Hospital, Southern Medical University, Guangzhou, China.
Medicine (Baltimore). 2018 Mar;97(13):e0238. doi: 10.1097/MD.0000000000010238.
The effects of revascularization by percutaneous coronary intervention (PCI) on cardiac function and clinical outcomes in patients with confirmed coronary artery disease (CAD) and heart failure (HF), on the basis of the optimal medical treatment recommended by current guidelines, remain to be determined.A cohort study was performed to evaluate the efficacy of PCI on the basis of optimal medical treatment in patients with CAD and HF. Patients who received PCI were subsequently grouped according to partial and complete revascularization (CR) depending on the PCI outcome. The primary outcome was defined as a composite outcome of major adverse cardiovascular events (MACEs). Changes in left ventricular ejection fraction (LVEF) also were compared.A total of 69 patients (12 who received medical treatment and 57 who received PCI) were included. Patients in the PCI group showed significantly improved LVEF (P < .001), but patients in the medical treatment group did not (P > .05) after 3 months of follow-up. MACEs occurred in 50% patients in the medical treatment group and 19.3% patients of the PCI group, with this difference almost reaching statistical significance (P = .06). Compared with patients who received medical therapy only, patients who received PCI experienced better survival (P = .02). Moreover, survival seemed to be better in patients who achieved CR with PCI of the coronary arteries than in those who had partial revascularization of the coronary arteries (P = .06).PCI may be effective for improving survival in patients with CAD and HF.
在当前指南推荐的最佳药物治疗基础上,经皮冠状动脉介入治疗(PCI)对确诊为冠状动脉疾病(CAD)和心力衰竭(HF)患者的心功能及临床结局的影响仍有待确定。进行了一项队列研究,以评估在CAD和HF患者中基于最佳药物治疗的PCI疗效。根据PCI结果,将接受PCI的患者随后按部分血运重建和完全血运重建(CR)进行分组。主要结局定义为主要不良心血管事件(MACE)的复合结局。还比较了左心室射血分数(LVEF)的变化。
总共纳入了69例患者(12例接受药物治疗,57例接受PCI)。随访3个月后,PCI组患者的LVEF显著改善(P<0.001),而药物治疗组患者则未改善(P>0.05)。药物治疗组50%的患者发生了MACE,PCI组为19.3%,这种差异几乎达到统计学意义(P=0.06)。与仅接受药物治疗的患者相比,接受PCI的患者生存率更高(P=0.02)。此外,冠状动脉PCI实现CR的患者的生存率似乎高于冠状动脉部分血运重建的患者(P=0.06)。
PCI可能对改善CAD和HF患者的生存率有效。