Frutkin Andrew D, Lindsey Jason B, Mehta Sameer K, House John A, Spertus John A, Cohen David J, Rumsfeld John S, Marso Steven P
Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO 64111, USA.
JACC Cardiovasc Interv. 2009 Jul;2(7):614-21. doi: 10.1016/j.jcin.2009.05.001.
Our purpose was to evaluate percutaneous coronary intervention (PCI) attempt rates in patients with class I indications for coronary artery bypass graft (CABG) surgery after the introduction of drug-eluting stents (DES).
In patients with severe, multivessel coronary disease, CABG has historically been recommended over PCI. Practice guidelines for CABG were last updated before the emergence of data on DES efficacy.
We analyzed 265,028 procedures from the NCDR (National Cardiovascular Data Registry) meeting American College of Cardiology/American Heart Association class I indications for surgical revascularization. Temporal trends in PCI attempt rates were analyzed during 3 consecutive time periods: pre-DES (before April 1, 2003), DES diffusion (April 1, 2003 to December 31, 2004), and DES (January 1, 2005 to September 30, 2006).
The attempted rate of PCI in patients with class I indications for CABG increased over the 3 time periods (pre-DES: 29.4%, DES diffusion: 33.4%, and DES era: 34.7%, p < 0.001). In a hierarchical multivariable logistic model adjusting for patient and PCI site characteristics, PCI attempts were more likely in the DES compared with pre-DES era (odds ratio: 1.44, 95% confidence interval: 1.40 to 1.48) and the DES diffusion era (odds ratio: 1.20, 95% confidence interval: 1.17 to 1.23). PCI attempt rates increased in all 3 time periods, although the average rate of increase during the DES era was 0.6% per quarter compared with 0.3% per quarter for both the DES diffusion and the pre-DES eras (p = 0.03).
DES use in clinical practice was associated with a significant overall increase in PCI to treat patients with class I indications for CABG. Long-term follow-up of this cohort of patients is warranted.
我们的目的是评估药物洗脱支架（DES）引入后，冠状动脉旁路移植术（CABG）手术I类适应证患者的经皮冠状动脉介入治疗（PCI）尝试率。
在患有严重多支冠状动脉疾病的患者中，历史上推荐CABG而非PCI。CABG的实践指南上次更新是在DES疗效数据出现之前。
我们分析了来自国家心血管数据注册库（NCDR）的265,028例符合美国心脏病学会/美国心脏协会手术血运重建I类适应证的手术。在3个连续时间段分析PCI尝试率的时间趋势：DES前（2003年4月1日前）、DES普及期（2003年4月1日至2004年12月31日）和DES期（2005年1月1日至2006年9月30日）。
CABG I类适应证患者的PCI尝试率在这3个时间段有所增加（DES前：29.4%，DES普及期：33.4%，DES时代：34.7%，p<0.001）。在调整患者和PCI部位特征的分层多变量逻辑模型中，与DES前时代相比，DES时代进行PCI尝试的可能性更大（优势比：1.44，95%置信区间：1.40至1.48），与DES普及期相比也是如此（优势比：1.20，95%置信区间：1.17至1.23）。PCI尝试率在所有3个时间段均有所增加，尽管DES时代的平均增长率为每季度0.6%，而DES普及期和DES前时代均为每季度0.3%（p = 0.03）。
在临床实践中使用DES与治疗CABG I类适应证患者的PCI总体显著增加相关。对这组患者进行长期随访是有必要的。
