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Change in Left Ventricular Ejection Fraction With Coronary Artery Revascularization and Subsequent Risk for Adverse Cardiovascular Outcomes
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2022-04-12 , DOI: 10.1161/circinterventions.121.011284 Raghava S Velagaleti 1 , Joy Vetter 2 , Rachel Parker 2 , Katherine E Kurgansky 2 , Yan V Sun 3, 4 , Luc Djousse 2, 5 , J Michael Gaziano 2, 5 , David Gagnon 2 , Jacob Joseph 1, 6
Circulation: Cardiovascular Interventions ( IF 5.6 ) Pub Date : 2022-04-12 , DOI: 10.1161/circinterventions.121.011284 Raghava S Velagaleti 1 , Joy Vetter 2 , Rachel Parker 2 , Katherine E Kurgansky 2 , Yan V Sun 3, 4 , Luc Djousse 2, 5 , J Michael Gaziano 2, 5 , David Gagnon 2 , Jacob Joseph 1, 6
Affiliation
Background:Coronary revascularization is recommended to treat ischemic cardiomyopathy. However, the relations of revascularization-associated ejection fraction (EF) change to subsequent outcomes have not been elucidated.Methods:In 10 071 veterans (mean age 67 years; 1% women; 15% non-White) who underwent a first percutaneous coronary intervention (PCI) or coronary artery bypass grafting between January 1, 1995, and December 31, 2010, and had prerevascularization and postrevascularization EF measured, we calculated delta-EF (postprocedure EF–preprocedure EF). We related delta-EF as a continuous measure and as categories (≤−5, −5<delta-EF<0, delta-EF=0, 0<delta-EF<5, and delta-EF≥5) to death (using Cox regression) and heart failure hospitalization days (using negative binomial regression) in multivariable-adjusted models, for total sample, and PCI and coronary artery bypass grafting strata.Results:Over follow-up (mean/maximum 5/14 years) 56% died. Each 5% improvement in delta-EF was associated with statistically significant reductions in death and heart failure hospitalization days of 5% (95% CI, 3%–7%) and 10% (95% CI, 5%–15%), respectively, in the total sample and 6% (95% CI, 4%–8%) and 10% (95% CI, 5%–16%), respectively, in the PCI subgroup. Patients in the highest delta-EF category had 27% (95% CI, 19%–34%) lower mortality (30% [95% CI, 21%–37%] lower in PCI stratum) and ≈40% lower heart failure hospitalization days in total sample and PCI stratum, compared with those in the lowest category. Relations of delta-EF and outcomes in coronary artery bypass grafting subgroup did not reach statistical significance.Conclusions:Revascularization-associated EF improvement was associated with significant reductions in mortality and heart failure hospitalization burden, particularly in the PCI subgroup.
中文翻译:
左心室射血分数随冠状动脉血运重建的变化以及随后心血管不良结局的风险
背景:推荐冠状动脉血运重建术治疗缺血性心肌病。然而,血运重建相关射血分数 (EF) 变化与后续结果之间的关系尚未阐明。方法:在 10071 名退伍军人(平均年龄 67 岁;1% 为女性;15% 为非白人)中,他们接受了首次经皮冠状动脉手术在 1995 年 1 月 1 日至 2010 年 12 月 31 日期间接受过介入治疗 (PCI) 或冠状动脉旁路移植术,并测量了血运重建前和血运重建后的 EF,我们计算了 delta-EF(术后 EF-术前 EF)。我们将 delta-EF 作为连续测量和分类(≤−5、−5<delta-EF<0、delta-EF=0、0<delta-EF<5 和 delta-EF≥5)与死亡相关(在多变量调整模型中使用 Cox 回归)和心力衰竭住院天数(使用负二项式回归),对于总样本、PCI 和冠状动脉旁路移植术分层。结果:随访期间(平均/最长 5/14 年)56% 死亡。delta-EF 每提高 5% 与死亡和心力衰竭住院天数显着减少 5%(95% CI,3%–7%)和 10%(95% CI,5%–15%)相关,具有统计学意义,分别在总样本和 6%(95% CI,4%–8%)和 10%(95% CI,5%–16%)中,在 PCI 亚组中。最高 delta-EF 类别的患者死亡率降低 27%(95% CI,19%–34%)(PCI 层降低 30% [95% CI,21%–37%]),心力衰竭降低约 40%总样本和 PCI 层的住院天数与最低类别的住院天数相比。冠状动脉旁路移植术亚组 delta-EF 与结局的关系未达到统计学意义。结论:
更新日期:2022-04-12
中文翻译:
左心室射血分数随冠状动脉血运重建的变化以及随后心血管不良结局的风险
背景:推荐冠状动脉血运重建术治疗缺血性心肌病。然而,血运重建相关射血分数 (EF) 变化与后续结果之间的关系尚未阐明。方法:在 10071 名退伍军人(平均年龄 67 岁;1% 为女性;15% 为非白人)中,他们接受了首次经皮冠状动脉手术在 1995 年 1 月 1 日至 2010 年 12 月 31 日期间接受过介入治疗 (PCI) 或冠状动脉旁路移植术,并测量了血运重建前和血运重建后的 EF,我们计算了 delta-EF(术后 EF-术前 EF)。我们将 delta-EF 作为连续测量和分类(≤−5、−5<delta-EF<0、delta-EF=0、0<delta-EF<5 和 delta-EF≥5)与死亡相关(在多变量调整模型中使用 Cox 回归)和心力衰竭住院天数(使用负二项式回归),对于总样本、PCI 和冠状动脉旁路移植术分层。结果:随访期间(平均/最长 5/14 年)56% 死亡。delta-EF 每提高 5% 与死亡和心力衰竭住院天数显着减少 5%(95% CI,3%–7%)和 10%(95% CI,5%–15%)相关,具有统计学意义,分别在总样本和 6%(95% CI,4%–8%)和 10%(95% CI,5%–16%)中,在 PCI 亚组中。最高 delta-EF 类别的患者死亡率降低 27%(95% CI,19%–34%)(PCI 层降低 30% [95% CI,21%–37%]),心力衰竭降低约 40%总样本和 PCI 层的住院天数与最低类别的住院天数相比。冠状动脉旁路移植术亚组 delta-EF 与结局的关系未达到统计学意义。结论: