左心室射血分数对左主干血运重建术后结局的影响：g-LM注册研究
Impact of left ventricular ejection fraction on outcomes after left main revascularization: g-LM Registry.
作者信息
Daoulah Amin, Naser Maryam Jameel, Hersi Ahmad S, Alshehri Mohammed, Garni Turki Al, Abuelatta Reda, Yousif Nooraldaem, Almahmeed Wael, Alasmari Abdulaziz, Aljohar Alwaleed, Alzahrani Badr, Abumelha Bader K, Ghani Mohamed Ajaz, Amin Haitham, Hashmani Shahrukh, Hiremath Niranjan, Kazim Hameedullah M, Refaat Wael, Selim Ehab, Jamjoom Ahmed, El-Sayed Osama, Al-Faifi Salem M, Feteih Maun N, Dahdouh Ziad, Aithal Jairam, Ibrahim Ahmed M, Elganady Abdelmaksoud, Qutub Mohammed A, Alama Mohamed N, Abohasan Abdulwali, Hassan Taher, Balghith Mohammed, Hussien Adnan Fathey, Abdulhabeeb Ibrahim A M, Ahmad Osama, Ramadan Mohamed, Alqahtani Abdulrahman H, Alshahrani Saif S, Qenawi Wael, Shawky Ahmed, Ghonim Ahmed A, Elmahrouk Ahmed, Alhamid Sameer, Maghrabi Mohamed, Haddara Mamdouh M, Iskandar Mina, Shawky Abeer M, Hurley William T, Elmahrouk Youssef, Ahmed Waleed A, Lotfi Amir
机构信息
Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.
Department of Internal Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Springfield, Massachusetts, USA.
出版信息
J Cardiovasc Med (Hagerstown). 2023 Jan 1;24(1):23-35. doi: 10.2459/JCM.0000000000001383. Epub 2022 Oct 11.
AIMS
The impact of left ventricular dysfunction on clinical outcomes following revascularization is not well established in patients with unprotected left main coronary artery disease (ULMCA). In this study, we evaluated the impact of left ventricular ejection fraction (LVEF) on clinical outcomes of patients with ULMCA requiring revascularization with percutaneous coronary intervention (PCI) compared with coronary artery bypass graft (CABG).
METHODS
The details of the design, methods, end points, and relevant definitions are outlined in the Gulf Left Main Registry: a retrospective, observational study conducted between January 2015 and December 2019 across 14 centres in 3 Gulf countries. In this study, the data on patients with ULMCA who underwent revascularization through PCI or CABG were stratified by LVEF into three main subgroups; low (l-LVEF <40%), mid-range (m-LVEF 40-49%), and preserved (p-LVEF ≥50%). Primary outcomes were hospital major adverse cardiovascular and cerebrovascular events (MACCE) and mortality and follow-up MACCE and mortality.
RESULTS
A total of 2137 patients were included; 1221 underwent PCI and 916 had CABG. During hospitalization, MACCE was significantly higher in patients with l-LVEF [(10.10%), P = 0.005] and m-LVEF [(10.80%), P = 0.009], whereas total mortality was higher in patients with m-LVEF [(7.40%), P = 0.009] and p-LVEF [(7.10%), P = 0.045] who underwent CABG. There was no mortality difference between groups in patients with l-LVEF. At a median follow-up of 15 months, there was no difference in MACCE and total mortality between patients who underwent CABG or PCI with p-LVEF and m-LVEF.
CONCLUSION
CABG was associated with higher in-hospital events. Hospital mortality in patients with l-LVEF was comparable between CABG and PCI. At 15 months' follow-up, PCI could have an advantage in decreasing MACCE in patients with l-LVEF.
目的
在无保护左主干冠状动脉疾病（ULMCA）患者中，左心室功能障碍对血运重建术后临床结局的影响尚未明确。在本研究中，我们评估了左心室射血分数（LVEF）对需要经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）进行血运重建的ULMCA患者临床结局的影响，并进行了比较。
方法
研究设计、方法、终点及相关定义的详细信息在海湾左主干登记研究中进行了概述：这是一项回顾性观察研究，于2015年1月至2019年12月在3个海湾国家的14个中心开展。在本研究中，通过PCI或CABG进行血运重建的ULMCA患者数据按LVEF分层为三个主要亚组：低LVEF（l-LVEF<40%）、中等范围LVEF（m-LVEF 40-49%）和保留LVEF（p-LVEF≥50%）。主要结局为住院期间主要不良心血管和脑血管事件（MACCE）、死亡率以及随访期MACCE和死亡率。
结果
共纳入2137例患者；1221例行PCI，916例行CABG。住院期间，l-LVEF患者（[10.10%]，P=0.005）和m-LVEF患者（[10.80%]，P=0.009）的MACCE显著更高，而接受CABG的m-LVEF患者（[7.40%]，P=0.009）和p-LVEF患者（[7.10%]，P=0.045）的总死亡率更高。l-LVEF患者组间死亡率无差异。在中位随访15个月时，p-LVEF和m-LVEF患者接受CABG或PCI后的MACCE和总死亡率无差异。
结论
CABG与更高的住院事件发生率相关。l-LVEF患者的住院死亡率在CABG和PCI之间相当。在15个月的随访中，PCI在降低l-LVEF患者的MACCE方面可能具有优势。
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