Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Am J Cardiol. 2024 Feb 15;213:86-92. doi: 10.1016/j.amjcard.2023.07.175. Epub 2024 Jan 9.
Coronary artery disease (CAD) is one of the main causes of heart failure (HF) with preserved ejection fraction (HFpEF). The efficacy of revascularization therapy in patients with HFpEF and CAD, however, remains unclear. Patients who underwent coronary angiography from January 2017 to December 2019 were included in this retrospective study if they further satisfied the diagnosis of HFpEF (left ventricular ejection fraction ≥50% plus plasma N-terminal pro-BNP ≥125 pg/ml) and CAD (patients had a history of confirmed myocardial infarction or ≥50% stenosis in at least 1 epicardial coronary vessel). Clinical data, way of revascularization, and outcome events (unplanned repeated revascularization, HF readmission, cardiovascular death, readmission of cerebral hemorrhage/stroke or gastrointestinal bleeding, and all-cause death) were recorded and analyzed. A total of 1,111 patients were enrolled for the present analysis. Based on whether the revascularization was complete or not, the patients were divided into the complete revascularization group (n = 780) and the incomplete/no revascularization group (n = 331). All patients were followed up with a median of 355 days. The overall rates of unplanned repeated revascularization, HF readmission, and cardiovascular death were 6.6%, 5.0%, and 0.4%, respectively. Compared with incompletely/not revascularized patients, completely revascularized patients had a lower rate of unplanned repeated revascularization (10.9% vs 4.7%, p <0.001) and cardiovascular death (0.9% vs 0.1%, p = 0.048). However, HF readmission, readmission of cerebral hemorrhage/stroke or gastrointestinal bleeding, and noncardiac death were comparable between the 2 groups. The regression analysis showed that hyperlipidemia, previous myocardial infarction, in-stent restenosis, and way of revascularization were associated with the composite events of unplanned repeated revascularization, HF readmission, and cardiovascular death during the follow-up. Complete revascularization may reduce unplanned repeated revascularization and cardiovascular death for patients with HFpEF and CAD.
冠心病（CAD）是射血分数保留型心力衰竭（HFpEF）的主要病因之一。然而，对于 HFpEF 和 CAD 患者，血运重建治疗的疗效仍不明确。本回顾性研究纳入了 2017 年 1 月至 2019 年 12 月期间接受冠状动脉造影的患者，如果进一步满足 HFpEF（左心室射血分数≥50%且血浆 N 末端脑钠肽前体≥125pg/ml）和 CAD（患者有明确的心肌梗死史或至少 1 个心外膜冠状动脉≥50%狭窄）的诊断标准，则被纳入研究。记录并分析了临床数据、血运重建方式和结局事件（计划外再次血运重建、HF 再入院、心血管死亡、再入院脑出血/中风或胃肠道出血、全因死亡）。共纳入 1111 例患者进行本分析。根据血运重建是否完全，患者分为完全血运重建组（n=780）和不完全/未血运重建组（n=331）。所有患者中位随访 355 天。计划外再次血运重建、HF 再入院和心血管死亡的总体发生率分别为 6.6%、5.0%和 0.4%。与不完全/未血运重建的患者相比，完全血运重建的患者计划外再次血运重建发生率较低（10.9% vs 4.7%，p<0.001），心血管死亡率较低（0.9% vs 0.1%，p=0.048）。然而，2 组 HF 再入院、脑出血/中风或胃肠道出血再入院以及非心脏性死亡发生率无差异。回归分析显示，高脂血症、既往心肌梗死、支架内再狭窄和血运重建方式与随访期间计划外再次血运重建、HF 再入院和心血管死亡的复合事件相关。对于 HFpEF 和 CAD 患者，完全血运重建可能减少计划外再次血运重建和心血管死亡。
