| BackgroundIschemic cardiomyopathy(ICM) belongs to a particular type or the later stage of coronary heart disease(CHD), coronary artery stenosis causes long-term myocardial ischemia, widespread fibrosis of myocardium, leading to the similar clinical syndrome of primary dilated cardiomyopathy(DCM). The mortality of coronary heart disease has declined over the past decades, but the result is that the prevalence of ischemic cardiomyopathy is rising, which is the most common cause of heart failure in the developed countries. Almost 60% hospitalized patients with heart failure registered in the United States has the history of coronary heart disease. American epidemiological data shows that about 5 million of patients with heart failure, of which at least 70% of the left ventricular systolic dysfunction are caused by ischemic cardiomyopathy. According to the epidemiological survey in China in 2010, the morbidity of coronary heart disease is(120~140) /100000.And the development of coronary heart disease can progress to ischemic cardiomyopathy, the diagnosis and treatment of ischemic cardiomyopathy has become an important issue in the medical field.Such patients with cardiac enlargement and cardiac function decline, ischemic cardiomyopathy with heart failure compared with non ischemic heart failure has poor treatment effect, despite the progress of medical technology, the mortality of ischemic cardiomyopathy remains high. Left ventricular function has been considered to be one strongest prognostic factors and 5 year mortality rate is about 50% to 84%, the survival rate is far lower than that of primary dilated cardiomyopathy. The chronic heart failure diagnosis and treatment guidelines of Chinese society of cardiology of Chinese Medical Association in 2007 show that the death caused by ischemic cardiomyopathy is as follows: 59% of pump failure, 13% of sudden death and 13% of arrhythmia, which is a problem in the field of the research of cardiovascular disease at home and abroad.At present, scholars at home and abroad on the treatment of ischemic cardiomyopathy is consistent, the main factor affecting the prognosis of patients is whether to carry out a complete revascularization, rather than the specific forms of operation. The revascularization including coronary artery interventional therapy and coronary artery bypass grafting. Clinical trials confirmed that CABG can improve the survival rate of ischemic cardiomyopathy patients with low LVEF, but CABG has a high risk of postoperative complications,the mortality of CABG is 5%- 30%. With the development of technology and the progress of the balloon, stent, guide wire in coronary intervention,our treatment of coronary heart disease(CHD) from PTCA, bare metal stents to now the drug eluting stent, drug coated balloon, from the original deal with the simplest type lesions to now bifurcation lesions, left main coronary artery disease, calcification and chronic total occlusion, accumulated valuable total experience and achieved remarkable achievements, complex lesions and chronic total occlusion is becoming the problem that cardiology experts are gonging to overcome. With progress of coronary artery interventional technology, many patients with coronary artery bypass grafting surgery can be through the intervention instead of surgery, domestic and international guidelines continue to relax the indications for PCI. Studies have indicated that percutaneous coronary intervention(PCI) can improve the cardiac function and clinical symptoms of patients with ischemic cardiomyopathy,it can also improve the long-term survival rate of patients with ischemic cardiomyopathy. Both animal experiments and clinical studies at home and abroad have indicated that the functional recovery of the myocardium is related to the improvement of the blood supply of the coronary artery. The study of the hibernating myocardium is more and more valued by scholars both at home and abroad. This study aims to observe percutaneous coronary intervention combined with medicine therapy and medical conservative treatment on cardiac function in patients and one year of major cardiovascular events cumulative incidence rate of ischemic cardiomyopathy, and to explore the further clinical treatment of ischemic cardiomyopathy. ObjectionTo study the influence of percutaneous coronary intervention(PCI) combined with medicine therapy and medical conservative treatment on the incidence of major adverse cardiovascular events and the cardiac function among the patients with ischemic cardiomyopathy. MethodsSelecting the newly diagnosed suspected ischemic cardiomyopathy patients 200 cases were randomly divided into 100 cases of PCI combined with medicine treatment group and 100 cases of medical conservative treatment group. All patients accept coronary angiography examination,120 patients with ischemic cardiomyopathy are confirmed,64 patients with PCI combined with medicine therapy group(group A) and 56 cases of medical conservative treatment group(group B). Results1.Sex ratio, age, smoking rate, coronary lesion vessels, body mass index, systolic blood pressure(SBP),diastolic blood pressure(DBP), and diabetes morbidity rate, low density lipoprotein and other clinical datas of two groups of patients showed no significant difference(P > 0.05);2.Two groups of patients were treated with PCI combined with medicine treatment or medical conservative treatment for one year,The improvement of the symptoms of heart failure in group A was better than that in group B, there is significant difference(?2=8.899, P = 0.003)3.Before treatment, the LVEDD of the two groups of patients is(60.80±3.22 VS 60.93±3.42), there is no significant difference(P=0.726),The two groups of patients were treated with PCI combined with medicine or medical conservative treatment one year later, the LVEDD group A and group B is less than before treatment, there was statistically significant difference(P=0.015, P=0.041), the LVEDD of group A is less than group B, there is statistical difference(P =0.026)4. Before treatment, the LVEF of the two groups of patients is(37.08±2.56 VS 40.72±3.58), there is no statistical difference(P =0.508)., Two groups of patients were treated with PCI combined with medicine or medical conservative treatment one year later, the LVEF group A and group B is significantly higher than before treatment, there is statistically different(P=0.012, P=0.032), the LVEF of group A is higher than the group B, there is statistical difference(P =0.023).5. Before treatment, the NT-proBNP of the two groups of patients is(4627.60±1492.79 VS 4687.40±1392.79), there is no significant difference(P=0.768), the two groups of patients were treated with PCI combined with medicine or medical conservative treatment one year later,the NT-proBNP of group A and group B is lower than before treatment, there is statistically significant difference(P =0.036,P=0.008), the NT-proBNP of group A is lower than group B, there is statistically significant difference(P=0.015).6. The incidence of major adverse cardiovascular events in group A is higher than that in group B, there is statistically significant difference(?2=5.557, P=0.018); the incidence of cardiac death in group A was lower than that in group B(P=0.025), P =0.085, the incidence of myocardial infarction and ischemic stroke in group A and group B, there was no significant difference((?2=0.043, P=0.835, P=0.467). Conclusions1.Percutaneous coronary intervention combined with medicine therapy and medical conservative treatment can improve heart function in patients with ischemic cardiomyopathy, percutaneous coronary intervention combined with medicine treatment on cardiac function in patients with ischemic cardiomyopathy is better than conservative medical treatment;2.Coronary intervention combined with medicine therapy in patients with ischemic cardiomyopathy can reduce the incidence of major cardiovascular events compared with medical conservative treatment. |
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