左心室射血分数降低的心力衰竭患者手术治疗的预后因素
Prognostic factors of surgical management for heart failure patients with reduced left ventricular ejection fraction.
作者信息
Abuharb Mahmoud Yousef Ibrahim, Kaiwen Liu, Zhuhui Huang, Kui Zhang, Jubing Zheng, Yue Song, Yang Li, Taoshuai Liu, Ran Dong
机构信息
Capital Medical University Affiliated Anzhen Hospital, Cardiovascular Surgery Department, 100029, China, Beijing.
出版信息
Heliyon. 2024 Feb 20;10(5):e26552. doi: 10.1016/j.heliyon.2024.e26552. eCollection 2024 Mar 15.
OBJECTIVES
There are many available pharmaceutical and surgical management for Coronary artery disease (CAD) patients. However, coronary artery bypass grafting (CABG) is the preferred treatment modality for CAD patients with low ejection fraction (EF) in view of the more favorable outcomes. This study aimed to determine the associated factors of poor outcomes post-CABG for heart failure patients with reduced left ventricular ejection fraction who underwent on-pump and off-pump CABG.
METHODS
A retrospective review of CAD patients who underwent isolated on-pump CABG (ONCAB) or off-pump CABG (OPCAB) in Beijing Anzhen Hospital Affiliated with Capital Medical University from January 2013 to March 2021. Only those with confirmed reduced left ventricular ejection fraction (LVEF) ≤40% on preoperative echocardiography were included. By analyzing the clinical and surgical data, postoperative mortality and morbidity, as well as major cardiovascular and cerebrovascular adverse events (MACCE) as endpoints, certain risk factors of the postoperative complications were identified.
RESULTS
Out of the 500 patients, 64 developed MACCE, of which 14 (13.6%) occurred in the ONCAB group and 50 (14.0%) in the OPCAB group. Univariate COX regression analysis showed that age ≥65 years, history of diabetes, and preoperative renal insufficiency were independent risk factors for postoperative primary endpoint events in CAD patients with heart failure with reduced ejection fraction (HFrEF). Following the multivariate COX regression analysis, in addition to the above three risk factors, a history of previous percutaneous coronary angiography (PCI) intervention was also a risk factor for the occurrence of the primary endpoints post-CABG.
CONCLUSION
Based on the analysis, significant predictors of post-CABG MACCE in patients with HFrEF included being older than 65 years old, having diabetes, preoperative renal insufficiency, and having previous PCI.
目的
对于冠心病（CAD）患者，有多种药物和手术治疗方法可供选择。然而，鉴于冠状动脉旁路移植术（CABG）能带来更有利的结果，它是左心室射血分数（EF）较低的CAD患者的首选治疗方式。本研究旨在确定接受体外循环和非体外循环CABG的左心室射血分数降低的心力衰竭患者CABG术后不良结局的相关因素。
方法
回顾性分析2013年1月至2021年3月在首都医科大学附属北京安贞医院接受单纯体外循环CABG（ONCAB）或非体外循环CABG（OPCAB）的CAD患者。仅纳入术前超声心动图证实左心室射血分数（LVEF）≤40%降低的患者。通过分析临床和手术数据、术后死亡率和发病率，以及以主要心血管和脑血管不良事件（MACCE）为终点，确定术后并发症的某些危险因素。
结果
500例患者中，64例发生MACCE，其中14例（13.6%）发生在ONCAB组，50例（14.0%）发生在OPCAB组。单因素COX回归分析显示，年龄≥65岁、糖尿病史和术前肾功能不全是射血分数降低的心力衰竭（HFrEF）CAD患者术后主要终点事件的独立危险因素。多因素COX回归分析后，除上述三个危险因素外，既往经皮冠状动脉造影（PCI）干预史也是CABG术后发生主要终点事件的危险因素。
结论
基于分析，HFrEF患者CABG术后MACCE的显著预测因素包括年龄大于65岁、患有糖尿病、术前肾功能不全和既往有PCI史。
Zotero 插件