| Objective:To evaulate the efficacy, safety and short-term prognosis of percautaneous transluminal coronary intervention treatment(PCI)in patients with severe heart failure(HF)caused by coronary heart diseaes,and meanwhile,to analyse the correlation between ECG dynamic ischemic changes and effects of PCI.Methods:The 53 patients with severe HF caused by coronary heart diseaes from September 2005 to February 2010,received coronary angiography(CAG) examination,of them 41 males and 12 females,age 67.2±9.1 years,44 patients undergone PCI after CAG, The B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),and ECG dynamic ischemic changes had been tested in all patients prior to PCI.Apart from one case taking 300mg aspirin and 600mg clopidogrel before operation,the other cases took 300mg aspirin,300mg clopidogrel one day before and on the morning of PCI,ordinary dose heparin was given during PCI.All the stents implanted were drug-eluting stent (DES).No assessment of myocardial residual viability had taken before PCI via dobutamine stress echocardiography or myocardial perfusion imaging.After PCI,symptomatic change was observed and made the qualitative assessment,the value of BNP was tested in the third day and the 1,4,8 week after PCI,and the LVEF was also detected in the 1,4,8 week after PCI.The efficacy, safety and 3-months short-term prognosis of PCI and the correlation between ECG dynamic ischemic changes and effects of PCI were evaulated.Results:The CAG showed that 1 case with severe two-vessel coronary disease and the others with three-vessel coronary artery disease,including 1 or 2 branch vessel chronic total occlusion,anterior descending artery(LAD) was involved in all patients.The 44 cases were undergone PCI in the meantime of CAG, and the remaining 9 cases were not suitable for interventional therapy,the success rate of PCI procedure was 97.7% (42/43), no death or worse of HF occurred during procdure.The symptoms visibly improved after PCI in 18 cases (41.9%),improved in 25 cases (58.1%), remained unchanged 0, the value of the BNP preoperative value was 1418.14±590.49pg/ml,the third day and the 1,4,8 week after PCI were 887.21±253.51pg/ml,640.00±177.44 pg/ml,292.56±144.19pg/ml, 224.77±144.76pg/ml respectively, and the paired t test with preoperative was significant statistically difference (P<0.001),the LVEF before PCI was 26.00±5.59% and the 1,4,8 week after PCI were 29.56±4.76%,35.05 4.14%,38.67±4.73% respectively,the paired t test with preoperative was significant statistically difference (P<0.001).The ECG dynamic ischemia changes was detected in 33 cases(group I) and no ECG dynamic ischemia changes in 20 cases (group II) before PCI,all the-data as abover had shown that group I was batter than groupⅡ.Except one case with chronic renal insufficiency died of cardiac shock during receiving conventional hemodialysis procedure,2 days after PCI,the other patients keep living without death,myocardial infarction or target vessel revascularization within 3 monthsConclusion:PCI is safty and effective method in the treatment of severe heart failure induced by coronary heart disease,can significantly improve clinical symptoms and left ventricular function.The results of PCI in patients with ECG dynamic ischemia changes preoperation are significantly better than the others with no ECG dynamic changes.The ECG dynamic ischemia change is the direct evidence of myocardial viability,and is a reliable indicator for predicting the clinical effect after PCI.The patients with severe HF caused by coronary heart diseaes can get a good short-term prognosis from PCI and long-term outcome need further observation.
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