Objective: To investigate the in-hospital and long-term outcomes of patients with left ventricular ejection fraction (LVEF) <50% undergoing percutaneous coronary intervention (PCI) . Methods: From January to December 2013, 10 445 consecutive patients who underwent PCI in Fuwai Hospital and the LVEF value was available were prospectively included. The patients were divided into LVEF≥50% group (9 896 cases) and LVEF<50% group (549 cases) . The in-hospital and 2-year clinical outcomes were compared between the 2 groups. The association between LVEF<50% and clinical outcomes was assessed using multivariable Cox regression analysis. Results: (1) Compared with LVEF ≥50% group, LVEF< 50% group had higher rates of in-hospital all-cause death (1.1% (6/549) vs. 0.2% (17/9 896) , P<0.01) , cardiac death (1.1% (6/549) vs. 0.1% (12/9 896) , P<0.01) , in-stent thrombosis (0.7% (4/549) vs. 0.2% (18/9 896) , P<0.01) , myocardial infarction (2.4% (13/549) vs. 1.2% (121/9 896) , P<0.05) ,and major adverse cardiovascular and cerebrovascular events (MACCE) which including death, myocardial infarction, revascularization, in-stent thrombosis, and stroke (3.6% (20/549) vs. 1.4% (137/9 896) , P<0.01) . (2) A total of 10 388 (99.5%) patients completed 2-year follow-up. Compared with LVEF ≥50% group, LVEF<50% group had higher rates of 2-year all-cause death (4.7% (26/549) vs. 1.0% (101/9 896) , P<0.01) , cardiac death (4.0% (22/549) vs. 0.5% (50/9 896) , P<0.01) , in-stent thrombosis (3.1% (17/549) vs. 0.7% (71/9 896) , P<0.001) , myocardial infarction (4.2% (23/549) vs. 1.9% (186/9 896) , P<0.01) ,and MACCE (17.9% (98/549) vs. 11.8% (1 172/9 896) , P<0.01) . There were no significant differences on the rates of 2-year target-vessel revascularization, bleeding and stroke between the two groups. (3) The multivariable Cox regression analysis demonstrated that LVEF< 50% was the independent risk factor of 2-year all-cause death (HR=2.47, 95%CI 1.49-4.08, P<0.01) , cardiac death (HR=3.25, 95%CI 1.79-5.90, P<0.01) , in-stent thrombosis (HR=4.19, 95%CI 2.39-7.34, P<0.01) , myocardial infarction (HR=2.00, 95%CI 1.26-3.16, P<0.01) , and MACCE (HR=1.40, 95%CI 1.13-1.74, P<0.01) . (4) After propensity score matching, all in-hospital outcomes were similar between the two groups, including all-cause death, cardiac death, in-stent thrombosis, myocardial infarction, revascularization, bleeding, stroke, and MACCE (all P>0.05) . After propensity score matching,the multivariable Cox regression analysis demonstrated that LVEF<50% was still an independent risk factor of 2-year all-cause death (HR=3.08, 95%CI 1.37-6.89, P<0.01) , cardiac death (HR= 4.12, 95%CI 1.53-11.07, P<0.01) ,and in-stent thrombosis (HR=3.82, 95%CI 1.27-11.5, P<0.05) . Conclusion: LVEF< 50% is an independent risk factor of 2-year all-cause death, cardiac death, and in-stent thrombosis in patients undergoing PCI, but it does not increase the risk of target-vessel revascularization, bleeding or stroke.
目的： 探讨左心室射血分数（LVEF）<50%的冠心病患者经皮冠状动脉介入治疗（PCI）术后的院内及远期预后。 方法： 采用前瞻性研究方法，连续入选2013年1至12月在阜外医院行PCI且有超声心动图LVEF资料的冠心病患者10 445例。按照LVEF值，将入选患者分为LVEF≥50%组（9 896例）和LVEF<50%组（549例）。比较2组患者PCI术后院内及2年临床预后，并采用多因素Cox回归分析LVEF<50%与PCI术后不良事件的相关性。 结果： （1）LVEF<50%组术后院内全因死亡[1.1%（6/549）比0.2%（17/9 896），P<0.01]、心原性死亡[1.1%（6/549）比0.1%（12/9 896），P<0.01]、支架内血栓形成[0.7%（4/549）比0.2%（18/9 896）, P<0.01]、心肌梗死[2.4%（13/549）比1.2%（121/9 896）, P<0.05]和主要不良心脑血管事件[包括死亡、心肌梗死、血运重建、支架内血栓形成和卒中，3.6%（20/549）比1.4%（137/9 896）, P<0.01]发生率均高于LVEF≥50%组。（2）10 388例（99.5%）患者完成PCI术后2年随访。LVEF<50%组术后2年全因死亡[4.7%（26/549）比1.0%（101/9 896）, P<0.01]、心原性死亡[4.0%（22/549）比0.5%（50/9 896）, P<0.01]、支架内血栓形成[3.1%（17/549）比0.7%（71/9 896）, P<0.01]、心肌梗死[4.2%（23/549）比1.9%（186/9 896）, P<0.01]和主要不良心脑血管事件[17.9%（98/549）比11.8%（1172/9 896）, P<0.01]发生率均高于LVEF≥50%组，而两组之间的靶血管重建、出血和卒中发生率差异均无统计学意义（P均>0.05）。（3）多因素Cox回归分析显示，LVEF<50%是PCI术后2年全因死亡（HR=2.47，95%CI 1.49~4.08，P<0.01）、心原性死亡（HR=3.25，95%CI 1.79~5.90，P<0.01）、支架内血栓形成（HR=4.19，95%CI 2.39~7.34，P<0.01）、心肌梗死（HR=2.00，95%CI 1.26~3.16，P<0.01）和主要不良心脑血管事件（HR=1.40，95%CI 1.13~1.74，P<0.01）的独立危险因素。（4）倾向性评分匹配后，两组之间的术后院内全因死亡、心原性死亡、支架内血栓形成、心肌梗死、再次血运重建、出血、卒中和主要不良心脑血管事件发生率差异均无统计学意义（P均>0.05）。多因素Cox回归分析显示，倾向性评分匹配后，LVEF<50%是PCI术后2年全因死亡（HR=3.08，95%CI 1.37~6.89，P<0.01）、心原性死亡（HR= 4.12, 95%CI 1.53~11.07, P<0.01）和支架内血栓形成（HR=3.82，95%CI 1.27~11.5，P<0.05）的独立危险因素。 结论： LVEF<50%是冠心病患者PCI术后2年全因死亡、心原性死亡及支架内血栓形成的独立危险因素，但不增加靶血管重建、出血及卒中的风险。.
Keywords: Angioplasty; Coronary artery disease; Prognosis.