Following-up Study And Analysis Of Influencing Factors In Coronary Heart Disease Patients With Reduced Left Ventircular Ejection Fraction After Percutaneous Coronary Intervention

Objectives: To estimate the security and long-term prognosis in coronary heartdisease patients with reduced left ventricular ejection fraction after percutaneouscoronary intervention, and to explore main risk factors that have importantinfluences on prognosis of these patients, and more, to probe prediction ofefficacy with EuroSCORE and GensiniSCORE in these patients.Methods: A total of411patients with left ventricular ejection fraction less than orequal to50%were enrolled from February2005to February2012,They weredivided into two groups，One group with left ventricular ejection fraction between41%to50%, another group with left ventricular ejection fraction less than orequal to40%.Clinical data, laboratory test, echocardiogram and coronaryangiography result were collected,and then count EuroSCORE andGensiniSCORE,record In-hospital MACCE，and analyse factors of prognosis ofthe patients with coronary heart disease and left ventricular dysfunctionaccording to long-term mortality.Conclusion: All the411coronary heart disease patients with reduced leftventricular ejection fraction after percutaneous coronary intervention werefollowed up. All cases were followed up for (962±593) days.338cases were maleand73cases were female,the male was more than female. There was no statisticaldifferences in left ventricular posterior wall thickness(LVPW) and interventricularseptum thickness(IVS). But there were statistical differences in the otherparameters of echocardiogram. The group with ejection fraction less than or equalto40%has larger chamber volume, higher EuroSCORE than the group withejection fraction between41%to50%. Cox regression model analysis showedthat LVEF（β=-0.071, p=0.000, OR=0.931,95%CI:0.897-0.966）, creatinine clearance（β=-0.018, p=0.000, OR=0.982,95%CI:0.973-0.992）,hemoglobin（β=-0.022,p=0.004,OR=0.979,95%CI:0.964-0.993）were protective factor,andadvanced age（β=-0.051, p=0.000, OR=1.052,95%CI:1.028-1.077）,NYHA grade（β=0.325, p=0.028, OR=1.384,95%CI:1.036-1.850）, LDL-C（β=0.356,p=0.023OR=1.428,95%CI:1.051-1.939）, GensiniSCORE（β=0.007, p=0.011,OR=1.007,95%CI:1.002-1.012） were danger factor. Kaplan-Meie survivalanalysis showed the survival of the group with ejection fraction less than orequal to40%was86.4%,71.9%,68.9%respectively in1,2and3years and thesurvival of the group ejection fraction between41%to50%was86.4%,71.9%,68.9%respectively in1,2,3years.The group with ejection fractionless than or equal to40%get more benefit from complete revascularization thanincomplete revascularization.Receiver operating characteristics (ROC) curveshowed areas under the EuroSCORE curve was0.793,and areas under theGensiniSCORE curve was0.619(P＜0.01). Long-term follow-up ROC curveshowed that areas under the curve approached, EuroSCORE had less predictivevalue to long-term survival.Conclusions：LVEF had predicted value of coronary heart disease patients withreduced left ventricular ejection fraction after percutaneous coronary intervention.The group with ejection fraction less than or equal to40%get more benefit fromcomplete revascularization than the group with ejection fraction between41%to50%after the24months. The patients with ejection fraction less than or equal to40%should get complete revascularization. EuroSCORE had more predictivevalue with In-hospital MACCE than long-term follow-up.