| BackgroundAlthough the prognosis of patients diagnosed with acute coronary syndromes(ACS)and an impaired left ventricular ejection fraction(LVEF≤50%)has improved after percutaneous coronary intervention(PCI),a variety of adverse events may still occur during follow-up,causing tremendous economic losses and social burden,which has become a significant public health problem.The causes of adverse events are complicated,some studies have found a correlation between LVEF and adverse events.However,the demographic characteristics,clinical features,and postoperative dynamic change of LVEF in this population are insufficient;further research is needed.ObjectiveOur research aims at finding out the characteristic and early LVEF change(ΔLVEF,defined as the difference between 3-month LVEF and the baseline LVEF)of these people,exploring the relationship between ΔLVEF and long-term prognosis after the first PCI,and discovering the influencing factors of major adverse cardiovascular and cerebrovascular events(MACCE),and comparing the predictive value of the adjusted prediction model with the commonly used GRACE score and HEART score of the ACS,to provide feasible suggestions for early prevention,intervention and clinical decision-making of the target population.MethodsOur retrospective cohort study enrolled patients with ACS and impaired LVEF admitted to the Cardiology Department of Xijing Hospital and successfully underwent their first PCI from January 2010 to December 2015.Results of echocardiography and other related tests and examinations were collected at the baseline and the 3-month,6-month,and 12-month after PCI.Early LVEF change(ΔLVEF)was categorized as a non-recovery group(ΔLVEF≤0),the slightly increased group(0<ΔLVEF≤14),and the significantly increased group(ΔLVEF>14).COX regression was used to analyze the relationship between ΔLVEF and MACCE.The ROC curve method was used to compare the predictive value of the adjusted prediction model with the GRACE score and HEART score for the prognosis of target patients.The primary endpoint was MACCE,a composite of all-cause mortality,cardiac death,revascularization,stroke,and all-cause readmission.The secondary endpoint was each component of MACCE.The endpoint of the adjusted prediction model included a composite of all-cause death,cardiovascular death,and revascularization.Results1.A total of 858 patients were enrolled,and 505 were finally included in the study by exclusion criterion.The baseline characteristics of the study population are: male patients predominated(86.1%),with 1.46 times more urban patients than rural patients,and 54.7%smoked.45.1% of patients had combined hypertension,while about 1/4(19.6%)had diabetes,and a history of chest pain was up to 63%,consistent with the characteristics of patients with complex coronary heart disease in previous studies.Associated risk scores(GRACE score and HEART score)were assessed as high risk,48.3% of the patients showed multi-vessel lesions by coronary angiography,and it is common for concomitant medication.2.The dynamic change of LVEF was most apparent at 3-month after PCI,while the changes were not evident at 3-month to 1 year.The overall LVEF trajectories showed an initial increase and then stable change.Repeated measures analysis of variance(RMANOVA)showed that there is no significant difference in LVEF between 3-month and 6-month,3-month and 12-month after operation(all P>0.05).3.There was a significant negative correlation between ΔLVEF and MACCE.Compared with the non-recovery group,the risk of MACCE decreased by 33%(H R=0.67,95%CI:0.51-0.88,P=0.005)in slightly increased groups and 57%(HR=0.43,95%CI:0.29-0.64,P<0.001)in significantly increased groups,respectively.4.There was no statistical difference among the three groups in the all-cause mortality rate,cardiac death rate,and revascularization rate(all P>0.05).The all-cause readmission rate in the non-recovery and slightly increased groups was higher than that in the significantly increased group(P<0.01).5.After adjusting for multiple factors,age(HR=1.015,95%CI:1.005-1.026,P=0.005),functional class Ⅲ-Ⅳ(HR=1.574,95%CI:1.167-2.123,P=0.003),hypertension(HR=1.331,95%CI:1.067-1.660,P=0.011),prior stroke(HR=2.067,95%CI:1.260-3.390,P=0.004),low density lipoprotein cholesterol(HR=1.164,95%CI:1.024-1.324,P=0.020),GGT(HR=1.004,95%CI:1.002-1.006,P<0.001),right coronary artery lesions(HR=1.386,95%CI:1.066-1.802,P=0.015)are risk factors for predicting MACCE.6.The GRACE and HEART scores did not prove to have strong predictive value for long-term MACE in the target population,with AUC of 0.658(95%CI:0.60-0.71)and0.639(95%CI:0.57-0.70)respectively.Although the adjusted prediction model had a higher diagnostic value with AUC of 0.734(95%CI:0.68-0.79)than the GRACE and HEART scores,(all P<0.05,Delong’s tests),further prospective external validation is still needed.Conclusion1.Cardiac function of the targeted population was in dynamic change after the first PCI.ΔLVEF is negatively correlated with prognosis,and ΔLVEF could be considered as a criterion for postoperative quality management.2.Age,functional class Ⅲ-Ⅳ,hypertension,previous stroke history,LDL-C,GGT,and right coronary artery disease were risk factors for predicting MACCE.3.The GRACE and HEART scores did not prove to have strong predictive value for long-term MACE in the target population.Applying the nomogram form adjusted predictive model in the future could encourage doctors and patients to make joint decisions,improve patients’ follow-up compliance and reduce the risk of adverse outcomes. |
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