Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Am J Cardiol. 2022 May 15;171:55-64. doi: 10.1016/j.amjcard.2022.01.062. Epub 2022 Mar 17.
This study aimed to evaluate the association between percutaneous coronary intervention (PCI) treatment and all-cause mortality in patients with ischemic heart failure with left ventricular systolic dysfunction and functional mitral regurgitation (FMR). We included 1,483 patients of which 39.5% (n = 586) had moderate-to-severe FMR. Multivariable Cox proportional hazard model was used to assess the association between PCI treatment and all-cause mortality. Furthermore, propensity score matching was used to account for nonrandom treatment assignment. In those with none-to-mild FMR, after a median follow-up of 3.1 years, the cumulative rate of all-cause mortality between the PCI and non-PCI groups was comparable (10.1% vs 14.2%), with an adjusted hazard ratio (HR) of 0.731 (95% confidence interval [CI] 0.438 to 1.221, p = 0.232). In those with moderate-to-severe FMR, after a median follow-up of 2.9 years, the cumulative rate of all-cause mortality was lower in the PCI group (20.4% vs 31.6%), with an adjusted HR of 0.660 (95% CI 0.469 to 0.929, p = 0.017). The result was confirmed with propensity matching (HR 0.596 and 95% CI 0.363 to 0.977, p = 0.038). The mortality benefit associated with PCI treatment in patients with moderate-to-severe FMR was consistent regardless of the age, gender, reason for admission, presence of diabetes mellitus, left ventricular ejection fraction value, left main and 3-vessels disease. In conclusion, in patients with ischemic heart failure with left ventricular systolic dysfunction and moderate-to-severe FMR, PCI treatment was associated with improvement in all-cause mortality. Randomized clinical trials are needed to confirm the current results.
本研究旨在评估经皮冠状动脉介入治疗（PCI）与左心室收缩功能障碍合并功能性二尖瓣反流（FMR）的缺血性心力衰竭患者全因死亡率之间的关系。共纳入 1483 例患者，其中 39.5%（n=586）为中重度 FMR。多变量 Cox 比例风险模型用于评估 PCI 治疗与全因死亡率之间的关系。此外，还使用倾向评分匹配来考虑非随机治疗分配。在 FMR 为无到轻度的患者中，中位随访 3.1 年后，PCI 组和非 PCI 组的全因死亡率累积率相当（10.1% vs 14.2%），调整后的风险比（HR）为 0.731（95%置信区间 [CI] 0.438 至 1.221，p=0.232）。在 FMR 为中重度的患者中，中位随访 2.9 年后，PCI 组的全因死亡率较低（20.4% vs 31.6%），调整后的 HR 为 0.660（95%CI 0.469 至 0.929，p=0.017）。倾向评分匹配也证实了这一结果（HR 0.596，95%CI 0.363 至 0.977，p=0.038）。在中重度 FMR 的患者中，无论年龄、性别、入院原因、是否合并糖尿病、左心室射血分数值、左主干病变和 3 支血管病变，PCI 治疗与死亡率降低相关。总之，在左心室收缩功能障碍合并中重度 FMR 的缺血性心力衰竭患者中，PCI 治疗与全因死亡率的改善相关。需要进行随机临床试验来证实目前的结果。
