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目的比较经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)对冠心病合并非重度左心功能不全患者预后的影响。方法选择2011年1月至2013年1月在首都医科大学宣武医院住院的冠心病合并非重度慢性心力衰竭行血运重建患者412例为研究对象,根据血运重建方式分为PCI组268例和CABG组144例。随访截止至2016年1月,随访主要终点事件为全因病死率,次要终点事件为非致死性心肌梗死、再次血运重建及主要不良心血管事件(MACE)发生率,比较PCI组与CABG组长期预后的差别。结果随访时间5(3,6)年,其中PCI组失访28例(10.4%),CABG组失访17例(11.8%)。住院期间总MACE、死亡、非致死性心肌梗死、靶血管血运重建(TVR)发生率两组间比较,差异无统计学意义(P>0.05);心功能变化比较,PCI组有效比例高于CABG组,无效比例PCI组低于CABG组(P<0.05)。随访期间,PCI组累积全因病死率低于CABG组(7.8%vs.19.4%,P<0.05),总MACE发生率低于CABG组(38.1%vs.43.8%,P<0.05);PCI组累积非致死性心肌梗死发生率、累积TVR率与CABG组的差异无统计学意义(P>0.05)。Cox模型多因素分析矫正后,PCI组总MACE发生率(HR=1.357,95%CI 1.105~1.729),全因病死率(HR=0.426,95%CI 0.121~0.753)仍低于CABG组(P<0.05);TVR率、非致死性心肌梗死的差异无统计学意义(P>0.05)。结论冠心病合并非重度心功能不全患者行PCI安全有效,与CABG组相比心功能改善更明显,可降低全因病死率和MACE。
Objective To compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) on the prognosis of patients with coronary artery disease and non-severe left ventricular dysfunction. Methods From January 2011 to January 2013, 412 patients with coronary heart disease and revascularization of coronary heart disease hospitalized at Xuanwu Hospital of Capital Medical University from January 2011 to January 2013 were enrolled. According to the method of revascularization, 268 patients were divided into PCI group 144 cases in CABG group. Follow-up to January 2016, the primary end point of follow-up was all-cause mortality and the secondary endpoint was non-fatal myocardial infarction, revascularisation and major adverse cardiac events (MACE). Comparisons between PCI group and CABG Group long-term prognosis difference. Results The follow-up time was 5 (3,6) years. There were 28 cases (10.4%) in the PCI group and 17 cases (11.8%) in the CABG group. There was no significant difference in the incidence of total MACE, death, non-fatal myocardial infarction and target vessel revascularization (TVR) between the two groups during hospitalization (P> 0.05). Compared with the changes of cardiac function, the effective ratio of PCI was higher CABG group, ineffective PCI group than CABG group (P <0.05). During follow-up, the cumulative all-cause mortality rate in PCI group was lower than that in CABG group (7.8% vs.19.4%, P <0.05), and the incidence of total MACE was lower than that in CABG group (38.1% vs.43.8%, P <0.05) The incidence of cumulative non-fatal myocardial infarction, cumulative TVR rate and CABG group, the difference was not statistically significant (P> 0.05). Cox model multivariate analysis showed that the overall incidence of MACE in PCI group was significantly lower than that in CABG group (HR = 1.357, 95% CI 1.105-1.729) and all-cause mortality (HR = 0.426, 95% CI 0.121-0.753) <0.05). There was no significant difference in TVR rate and non-fatal myocardial infarction (P> 0.05). Conclusions PCI is safe and effective in patients with coronary heart disease complicated with severe cardiac insufficiency. Compared with CABG group, cardiac function improvement is more obvious, and all-cause mortality and MACE can be decreased.