Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Evidenced-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Int J Cardiol. 2019 Mar 1;278:22-27. doi: 10.1016/j.ijcard.2018.10.062. Epub 2018 Oct 18.
Complete revascularization with PCI is not always achieved in patients with ischemic HF. Therefore, this study aimed to elucidate the prognostic impact of residual coronary stenosis (RS) after percutaneous coronary intervention (PCI) in patients with ischemic heart failure (HF).
We analyzed a total of 1307 patients with symptomatic HF and a history of PCI registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study. RS that was defined as the presence of ≥70% luminal stenosis in major coronary arteries at the last coronary angiography.
Among the study population, 851 patients (65.1%) had RS. During a median follow-up period of 3.2 years, patients with RS had higher all-cause mortality than those without it even after propensity score matching (21.9 vs. 11.6%, log-rank P = 0.027). Multivariable Cox hazard analysis also showed the negative impact of RS on all-cause death in ischemic HF patients [hazard ratio (HR):1.62, 95% confidence interval (CI): 1.07-2.46, P = 0.024]. Importantly, when divided all subjects into three subgroups by left ventricular ejection fraction (LVEF) [LVEF < 40% (HFrEF), LVEF 40-49% (HFmrEF), and LVEF ≥ 50% (HFpEF)], inverse probability of treatment weighted method provided a similar result that RS after PCI was an independent risk factor for death in the HFpEF [HR(95%CI); 1.94(1.22-3.09), P < 0.01] and HFmrEF [4.47(1.13-14.98), P < 0.01] groups, but not in the HFrEF group [1.20(0.59-2.43), P = 0.62].
These results indicate that RS after PCI could aggravate long-term prognosis of ischemic HF patients with moderate- to well-preserved EF, but not those with reduced EF.
在缺血性心力衰竭患者中，经皮冠状动脉介入治疗（PCI）并非总能实现完全血运重建。因此，本研究旨在阐明 PCI 后残余冠状动脉狭窄（RS）对缺血性心力衰竭（HF）患者预后的影响。
我们分析了在我们的东北地区慢性心力衰竭分析和注册研究（CHART-2）中登记的 1307 例有症状的 HF 病史和 PCI 史的患者。RS 定义为最后一次冠状动脉造影时主要冠状动脉存在≥70%的管腔狭窄。
在研究人群中，851 例（65.1%）患者存在 RS。在中位随访 3.2 年期间，即使在倾向评分匹配后，RS 患者的全因死亡率也高于无 RS 患者（21.9%比 11.6%，log-rank P=0.027）。多变量 Cox 风险分析也显示 RS 对缺血性 HF 患者全因死亡的负面影响[风险比（HR）：1.62，95%置信区间（CI）：1.07-2.46，P=0.024]。重要的是，当根据左心室射血分数（LVEF）将所有受试者分为三组[LVEF<40%（HFrEF）、LVEF 40-49%（HFmrEF）和 LVEF≥50%（HFpEF）]时，逆概率治疗加权法提供了类似的结果，即 PCI 后 RS 是 HFpEF [HR（95%CI）；1.94（1.22-3.09），P<0.01]和 HFmrEF [4.47（1.13-14.98），P<0.01]组死亡的独立危险因素，但在 HFrEF 组中并非如此[1.20（0.59-2.43），P=0.62]。
这些结果表明，PCI 后 RS 可加重 EF 中度至较好保留的缺血性 HF 患者的长期预后，但不能加重 EF 降低的患者的预后。
