Independent and cumulative association of clinical and morphological heart failure with long-term outcome after percutaneous coronary intervention
Independent and cumulative association of clinical and morphological heart failure with long-term outcome after percutaneous coronary intervention
复制标题
临床和形态学心力衰竭与经皮冠状动脉介入治疗后长期结局的独立和累积关联
DOI：
10.1016/j.jjcc.2020.06.014
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发表时间：
2021
影响因子：
2.5
通讯作者：
Kohsaka Shun
中科院分区：
文献类型：
--
作者：
Kimura Mai;Kohno Takashi;Sawano Mitsuaki;Heidenreich Paul A.;Ueda Ikuko;Takahashi Toshiyuki;Matsubara Takashi;Ueno Koji;Hayashida Kentaro;Yuasa Shinsuke;Ohki Takahiro;Fukuda Keiichi;Kohsaka Shun
背景心力衰竭（HF）是血管重建术后不良预后的危险因素;然而，左心室收缩功能障碍（LVSD）和临床HF症状如何影响经皮冠状动脉介入治疗（PCI）的预后尚不清楚。我们调查了临床HF或LVSD患者PCI.MethodsThis后的特点和长期结果是一个日本的多中心注册研究的成年患者接受PCI。在2009年1月至2012年12月在15家医院接受PCI的4689例连续患者中，我们分析了2634例（56.2%）记录了左心室射血分数（LVEF）。根据临床HF（症状或HF住院）和LVEF [≥35%和<35%（LVSD导致的HF）]将他们分为4组。主要结局是主要不良心血管事件（MACE），包括全因死亡、急性冠状动脉综合征、HF住院、冠状动脉旁路移植术的性能和首次PCI后2年内的卒中。（13.4%）伴HF（临床HF，n = 173，48.9%; LVSD，n = 132，37.3%;两者，n = 49; 13.8%）。临床HF或LVSD患者的MACE发生率较高，主要是由于非心源性死亡和HF住院率较高。调整后，临床HF（风险比2.16，95%置信区间; 1.49 - 3.14）和LVEF降低（每10%，风险比0.89，95%置信区间; 0.81 - 0.99）与较高的MACE风险独立相关。结论临床HF和LVSD与不良长期临床结局独立相关，特别是与非心源性死亡和HF再入院，接受PCI治疗的患者。
BackgroundHeart failure (HF) is a risk factor for adverse post-procedural outcome after revascularization; however, it is unclear how left ventricular systolic dysfunction (LVSD) and clinical HF symptoms affect percutaneous coronary intervention (PCI) outcomes. We investigated the characteristics and long-term outcomes of patients with clinical HF or LVSD after PCI.MethodsThis was a Japanese multicenter registry study of adult patients receiving PCI. Among 4689 consecutive patients who underwent PCI at 15 hospitals from January 2009 to December 2012, we analyzed 2634 (56.2%) with documented left ventricular ejection fraction (LVEF). They were divided into four groups based on clinical HF (symptoms or HF hospitalization) and LVEF [≥35% and <35% (HF due to LVSD)]. The primary outcome was major adverse cardiovascular events (MACE), comprising all-cause death, acute coronary syndrome, HF hospitalization, performance of coronary artery bypass grafting, and stroke within 2 years after the initial PCI.ResultsOur findings revealed 354 patients (13.4%) with HF (clinical HF, n = 173, 48.9%; LVSD, n = 132, 37.3%; both, n = 49; 13.8%). The incidence of MACE was higher in patients with clinical HF or LVSD, and was largely due to higher non-cardiac death and HF hospitalization. After adjustment, clinical HF (hazard ratio 2.16, 95% confidence interval; 1.49−3.14) and lower LVEF (per 10%, hazard ratio 0.89, 95% confidence interval; 0.81−0.99) were independently associated with higher MACE risk.ConclusionsClinical HF and LVSD were independently associated with adverse long-term clinical outcomes, particularly with non-cardiac death and HF readmission, in patients treated with PCI.