Hannan Edward L, Racz Michael, Holmes David R, King Spencer B, Walford Gary, Ambrose John A, Sharma Samin, Katz Stanley, Clark Luther T, Jones Robert H
State University of New York, University at Albany, Rensselaer, NY 12144-3456, USA.
Circulation. 2006 May 23;113(20):2406-12. doi: 10.1161/CIRCULATIONAHA.106.612267. Epub 2006 May 15.
The importance of completeness of revascularization by percutaneous coronary intervention in patients with multivessel disease is unclear in that there is little information on the impact of incomplete revascularization outside of randomized trials. The objective of this study is to compare long-term mortality and subsequent revascularization for percutaneous coronary intervention patients receiving stents who were completely revascularized (CR) with those who were incompletely revascularized (IR).
Patients from New York State's Percutaneous Coronary Interventions Reporting System were subdivided into patients who were CR and IR. Then subsets of IR patients were contrasted with CR patients. Differences in long-term survival and subsequent revascularization for CR and IR patients were compared after adjustment for differences in preprocedural risk. A total of 68.9% of all stent patients with multivessel disease who were studied were IR, and 30.1% of all patients had total occlusions and/or > or =2 IR vessels. At baseline, the following patients were at higher risk: those who were older and those with more comorbid conditions, worse ejection fraction, and more renal disease and stroke. After adjustment for these baseline differences, IR patients were significantly more likely to die at any time (adjusted hazard ratio=1.15; 95% confidence interval, 1.01 to 1.30) than CR patients. IR patients with total occlusions and a total of > or =2 IR vessels were at the highest risk compared with CR patients (hazard ratio=1.36; 95% confidence interval, 1.12 to 1.66).
IR with stenting is associated with an adverse impact on long-term mortality, and consideration should be given to either achieving CR, opting for surgery, or monitoring percutaneous coronary intervention patients with IR more closely after discharge.
在多支血管病变患者中，经皮冠状动脉介入治疗实现血管再通完整性的重要性尚不清楚，因为在随机试验之外，关于不完全血管再通影响的信息很少。本研究的目的是比较接受支架置入术且实现完全血管再通（CR）的经皮冠状动脉介入治疗患者与不完全血管再通（IR）患者的长期死亡率和后续血管再通情况。
来自纽约州经皮冠状动脉介入治疗报告系统的患者被分为CR组和IR组。然后将IR组患者的亚组与CR组患者进行对比。在对术前风险差异进行调整后，比较CR组和IR组患者在长期生存和后续血管再通方面的差异。在所有接受研究的多支血管病变支架置入患者中，共有68.9%为IR组，30.1%的患者存在完全闭塞和/或≥2支IR血管。在基线时，以下患者风险较高：年龄较大者、合并症较多者、射血分数较差者以及肾病和中风患者较多者。在对这些基线差异进行调整后，IR组患者在任何时候死亡的可能性均显著高于CR组患者（调整后的风险比=1.15；95%置信区间，1.01至1.30）。与CR组患者相比，存在完全闭塞且共有≥2支IR血管的IR组患者风险最高（风险比=1.36；95%置信区间，1.12至1.66）。
支架置入术不完全血管再通与长期死亡率的不良影响相关，应考虑实现CR、选择手术或在出院后更密切地监测IR的经皮冠状动脉介入治疗患者。
