The Study On Revascularization By PCI For Chronic Heart Failure Patients With Coronary Artery Disease And The Results Of 2-year Follow-up

Objective To study the efficacy of PCI on chronic heart failure patients with CAD and long-term outcomes.Methods Since October 2014 to March 2015,chronic heart failure patients with coronary artery disease were selected from the General Army Hospital,all of them had gone through the examination of coronary angiography and the results definitely tips that they suffered from left main lesions?multiple vessels or proximal anterior descending lesions?chronic total occlusion lesions.75 cases were revascularized by PCI and the drug-eluting stent were implanted successfully.This study recruited the cases(105)of our team's earlier study(from March 2013 to September 2014),who have been followed up 6 months and this will be last 18 months.After the patients were admitted,the basics ? the level of NT-pro BNP ? left ventricular ejection fraction(LVEF)?6 minutes walking distance and NYHA heart function classification were recorded;the patients were followed-up by the way of outpatient care and telephone after they discharged.Total time of follow-up was 24 months,namely,the first month?sixth month?twelveth month and the twenty fourth month,the level of NT-pro BNP?left ventricular ejection fraction(LVEF)?6 minutes walking distance and NYHA heart function classification were recorded again.At the end of the follow-up,the number of readmission for heart failure?repeat revascularization?myocardial infarction?stroke and cardiac death were recorded.Compare the indexes of the study,between preoperative and postoperative,observe that whether the the difference has statistically significance or not.Result(1)184 patients were included in this study and 4patients loss to follow-up,the follow-up rate is97.8%.The average age of the patients is 71.6±9.07 and BMI (23.81±3.11kg/mm2)?LDL-C(2.84±1.11mmol/ml)?TG(1.52±0.95 mmol/ml)?ALT(35.74±15.54 mmol/ml)?e GFR(86.78±26.67 ml/min/1.73m2)?Hb(112.66±24.19g/L)?GLU(9.45±7.11 mmol/ml),LVEDD(63.01±8.07mm),NT-pro BNP(5040.2±3296.98pg/ml);the cases and percentage of male ? smoking ? hypertension ?hyperlipidaemia ? diabetes is 112/62.2% ? 113/62.8% ? 150/83.3% ? 133/73.9% ?85/47.2%,respectively;Guideline-directed medical therapy has been listed in the table 1.(2)Accoding to the Left Ventricular ejection fraction,all of the patients were classified three types: HFr EF,HFmr EF,HFp EF.Among the patients,HFr EF account for 50.6%,the percentage of HFmr EF is 36.1%,and HFp EF is 13.3% and HFr EF has higher proportion.(3)According to the results of coronary angiography,the cases and percentage of proximal anterior descending lesions?three-vessel lesions?left main diseases?chronic total occlusion lesions are 58 cases/32.2%?59 cases /32.8%?51 cases /28.3%?12 cases /6.7%,respectively,and the SYNTAX integral is calculated.(4)Compared with preoperative,the LVEF?6 minutes walking distance show the trends of increasing,and at the end of follow-up,they has significantly increase :LVEF(PCI Vs baseline 48.51%±5.65 Vs 36.76%±7.63,P < 0.01),6 minutes walking distance(PCI Vs baseline 486.9±100.50 Vs 181.6±91.05 P<0.01);the level of the BNP of the patiens present downtrend,and at the end of the follow-up,the BNP level has significantly decend:(24 months Vs basic line,1666.8±1486.20ng/ml Vs 5040.2±3296.98ng/ml,P < 0.01);there are significant improvement in NYHA classification(24 months Vs basic line,1.97±0.97 Vs 3.06±0.76,P<0.01).The LVEF of Patients,belonging to the types of HFr EF(24 months Vs basic line,43.99±4.16 Vs 30.88±5.34,P<0.01)and HFmr EF(24 months Vs basic line,50.61±4.24 Vs 44.20±2.62,P<0.01)has significantly improved;However,in terms of HFp EF,the difference of LVEF(24 months Vs basic line,55.96±4.68 Vs 53.88±2.52,P=0.434)has no statistically significance.(8)At the end of the follow-up,the cases and ratios of readmission for heart failure?all cause death?cardiac death are 35/19.4%?27/15%?21/11.7%,respectively,which are lower than that foreign countries reported.Among non-cardiac death patients,two patients died from renal failure,one patient died of severe pulmonary infection,one was from cachexia and another two were cerebral hemorrhage.Conclusion During long-term follow-up,among chronic heart failure patients with CAD,PCI can effectively improve part of the patients,heart function and exercise tolerance;it can minimize the rates of readmission for heart failure?all cause death and cardiac death.