Singh Mandeep, Rihal Charanjit S, Gersh Bernard J, Lennon Ryan J, Prasad Abhiram, Sorajja Paul, Gullerud Rachel E, Holmes David R
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Circulation. 2007 Jun 5;115(22):2835-41. doi: 10.1161/CIRCULATIONAHA.106.632679. Epub 2007 May 28.
Little is known about the impact of technological and pharmacological advances on long-term outcome after percutaneous coronary intervention in general clinical practice.
We analyzed in-hospital and long-term outcome of 24,410 percutaneous coronary interventions among 18,575 unique patients who underwent percutaneous coronary intervention at Mayo Clinic over 25 years. The study population was divided into group 1 (n=3708), coronary interventions from 1979 to 1989; group 2 (n=7020), interventions from 1990 to 1996; group 3 (n=10,952), interventions from 1996 to 2003; and group 4 (n=2730), interventions from 2003 to 2004. Despite the fact that patients in groups 3 and 4 were significantly older, sicker, and had greater prevalence of comorbid conditions, heart failure, and previous revascularization than those in groups 1 and 2, procedural success in groups 3 and 4 improved significantly (94%) versus groups 2 (89%) and 1 (78%) (P<0.001). Significant reduction in in-hospital mortality (groups 4 to 1: 1.8%, 1.7%, 2.6%, 3.0%; P<0.001) and need for emergency bypass surgery (groups 4 to 1: 0.4%, 0.5%, 1.6%, 5%; P<0.001) was noted in groups 3 and 4 compared with groups 1 and 2. Better adherence to currently recommended evidence-based medications for secondary prevention was seen in the recent time periods. After adjustment, significant reduction in follow-up mortality (hazard ratio, 0.81 and 0.74 for groups 3 and 4, respectively); death or myocardial infarction (hazard ratio, 0.80 and 0.75 for groups 3 and 4, respectively); death, myocardial infarction, or revascularization (hazard ratio, 0.76 and 0.58 for groups 3 and 4, respectively) was noted in recent time periods.
Despite higher-risk profiles of patients who underwent percutaneous coronary intervention in recent time periods, procedural success as well as in-hospital and long-term outcomes improved significantly over the last 25 years.
在一般临床实践中，关于技术和药理学进展对经皮冠状动脉介入治疗后长期预后的影响，人们了解甚少。
我们分析了梅奥诊所25年间18,575例接受经皮冠状动脉介入治疗的独特患者中24,410例经皮冠状动脉介入治疗的住院及长期预后情况。研究人群分为1组（n = 3708），1979年至1989年的冠状动脉介入治疗；2组（n = 7020），1990年至1996年的介入治疗；3组（n = 10,952），1996年至2003年的介入治疗；4组（n = 2730），2003年至2004年的介入治疗。尽管3组和4组患者比1组和2组患者年龄更大、病情更重，合并症、心力衰竭及既往血运重建的患病率更高，但3组和4组的手术成功率显著提高（94%），高于2组（89%）和1组（78%）（P<0.001）。与1组和2组相比，3组和4组的住院死亡率（4组至1组：1.8%、1.7%、2.6%、3.0%；P<0.001）和急诊搭桥手术需求（4组至1组：0.4%、0.5%、1.6%、5%；P<0.001）显著降低。近期更好地坚持了目前推荐的用于二级预防的循证药物治疗。调整后，近期观察到随访死亡率显著降低（3组和4组的风险比分别为0.81和0.74）；死亡或心肌梗死（3组和4组的风险比分别为0.80和0.75）；死亡、心肌梗死或血运重建（3组和4组的风险比分别为0.76和0.58）。
尽管近期接受经皮冠状动脉介入治疗的患者风险更高，但在过去25年中，手术成功率以及住院和长期预后均有显著改善。
