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目的了解心力衰竭发作前左室射血分数(LVEF)正常的冠心病患者的临床特点和长期预后。方法选择DESIRE(Drug-Eluting Stent I mpact on Revascularization)数据库中LVEF≥50%的患者的病例资料进行分析,了解患者的临床特征、住院和随访死亡率。结果在DESIRE注册的LVEF≥50%的2714例血运重建术后的冠心病患者中,35例在住院期间发生心力衰竭,88.6%心力衰竭患者合并多支血管病变,肾小球滤过率<60ml/min者占37.1%。这些患者血运重建术后住院死亡率显著高于其他患者(14.3%vs1.2%,P<0.001);出院后平均随访(475±244)d,心力衰竭发作前LVEF正常的患者随访死亡率显著高于其他患者(21.4%vs2.6%,P<0.001)。结论心力衰竭发作前LVEF正常的冠心病患者多数冠状动脉病变弥漫,肾功能受损的发生率较高。这些患者行血运重建术后院内死亡率和长期随访死亡率高,提示这组患者病情重,应加强药物治疗。
Objective To investigate the clinical features and long-term prognosis of patients with coronary heart disease with normal left ventricular ejection fraction (LVEF) before the onset of heart failure. Methods The data of patients with LVEF ≥50% in the database of Drug-Eluting Stent Impact on Revascularization (DESIRE) were analyzed to find out the clinical characteristics, hospitalization and follow-up mortality. Results Of the 2714 patients with coronary artery disease undergoing DESIRE with LVEF≥50% who underwent revascularization, 35 patients had heart failure during hospitalization, 88.6% of patients with heart failure complicated with multivessel disease, and glomerular filtration rate < 60ml / min accounted for 37.1%. In-hospital mortality after revascularization was significantly higher in these patients than in other patients (14.3% vs 1.2%, P <0.001); mean follow-up after discharge (475 ± 244) days, follow-up mortality in patients with normal LVEF before heart failure Significantly higher than other patients (21.4% vs 2.6%, P <0.001). Conclusion Most patients with normal LVEF before heart failure have diffuse coronary artery lesions and high incidence of impaired renal function. These patients underwent in-hospital mortality after revascularization and long-term follow-up mortality, suggesting that patients in this group were seriously ill and should be strengthened drug treatment.