Tamburino Corrado, Angiolillo Dominick J, Capranzano Piera, Dimopoulos Konstantinos, La Manna Alessio, Barbagallo Rossella, Tagliareni Francesco, Mangiafico Sarah, Guzman Luis A, Galassi Alfredo R, Bass Theodore A
Division of Cardiology, University of Catania, Catania, Italy.
Catheter Cardiovasc Interv. 2008 Oct 1;72(4):448-56. doi: 10.1002/ccd.21666.
To investigate the long-term prognostic implications of complete versus incomplete revascularization in multivessel coronary artery disease (MVD) patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES).
Coronary artery bypass grafting (CABG) in patients with MVD provides better outcomes when complete revascularization is achieved. There is a paucity of data on the outcomes of complete versus incomplete revascularization of MVD patients undergoing PCI, and currently there is no data available with DES.
Patients with MVD undergoing PCI with DES (sirolimus- or paclitaxel-eluting stent) were included. Comparisons of long-term outcomes between completely versus incompletely revascularized patients were made. The primary outcome measure was the composite of cardiac death, nonfatal myocardial infarction (MI), or any revascularization. Secondary endpoints were the components of the composite endpoint.
A total of 508 patients were considered for this analysis: 212 (41.7%) and 296 (58.3%) had complete and incomplete revascularization, respectively. The median follow-up was 27.0 (interquartile range: 23.0-37.1) months. After adjusting for baseline characteristics, the hazard ratio (HR, 95% confidence interval) for complete revascularization was 0.43 (0.29-0.63, P < 0.0001) for the primary composite endpoint. Complete revascularization was associated with better outcomes for components of the composite endpoint: 0.37 (0.15-0.92, P = 0.03) for cardiac death, 0.34 (0.16-0.75 P = 0.008) for the composite of cardiac death or MI and 0.45 (0.29-0.69, P = 0.0003) for any repeat revascularization. This association was confirmed in a propensity-matched population.
Complete revascularization with DES of MVD patients is associated with lower rates of long-term adverse events.
探讨多支冠状动脉疾病（MVD）患者接受药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）时，完全血运重建与不完全血运重建的长期预后意义。
对于MVD患者，当实现完全血运重建时，冠状动脉旁路移植术（CABG）可提供更好的预后。关于接受PCI的MVD患者完全血运重建与不完全血运重建的预后数据较少，目前尚无DES相关数据。
纳入接受DES（西罗莫司或紫杉醇洗脱支架）PCI的MVD患者。比较完全血运重建患者与不完全血运重建患者的长期预后。主要结局指标为心源性死亡、非致死性心肌梗死（MI）或任何血运重建的复合终点。次要终点为复合终点的组成部分。
本分析共纳入508例患者：分别有212例（41.7%）和296例（58.3%）实现了完全血运重建和不完全血运重建。中位随访时间为27.0（四分位间距：23.0 - 37.1）个月。在调整基线特征后，完全血运重建组主要复合终点的风险比（HR，95%置信区间）为0.43（0.29 - 0.63，P < 0.0001）。完全血运重建与复合终点各组成部分的较好预后相关：心源性死亡为0.37（0.15 - 0.92，P = 0.03），心源性死亡或MI的复合终点为0.34（0.16 - 0.75，P = 0.008），任何再次血运重建为0.45（0.29 - 0.69，P = 0.0003）。这种关联在倾向评分匹配人群中得到证实。
MVD患者使用DES进行完全血运重建与较低的长期不良事件发生率相关。
