Department of Cardiology, Johann Wolfgang Goethe-University, Frankfurt, Germany.
J Interv Cardiol. 2009 Dec;22(6):511-9. doi: 10.1111/j.1540-8183.2009.00498.x. Epub 2009 Sep 2.
AIMS/METHODS: Treatment of patients with multivessel coronary artery disease (CAD) has been an ongoing focus of recent clinical studies, questioning the ideal treatment. Randomized trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have so far only included a minority of screened patients. Therefore, we analyzed data from 679 consecutive "all-comer" patients, who underwent PCI in at least two main vessels. Expected in-hospital mortality for CABG was calculated using the EuroSCORE and compared to the observed mortality rate during in-hospital as well as long-term follow-up.
The patients were suffering from 2.5 +/- 0.6 diseased vessels, and 2.8 +/- 1.0 lesions were stented (32% of patients received at least one drug-eluting stent [DES]; 20% of lesions were treated with DES). Forty-seven percent of patients were treated for acute coronary syndrome (ACS) (N = 176 ST-elevation myocardial infarction [STEMI]; N = 140 non-ST-elevation myocardial infarction [NSTEMI]). The EuroSCORE was significantly higher in ACS patients compared to stable patients (logistic: STEMI 16.3 +/- 17.2; NSTEMI 13.6 +/- 13.0; stable CAD 3.9 +/- 4.2). The observed in-hospital mortality (STEMI 13.0%; NSTEMI 2.9%; stable CAD 1.7%, P < 0.001) was far lower than the estimated 30-day mortality. Cox regression analysis identified an elevated logistic EuroSCORE (HR per quartile 2.7, P = 0.003), severely reduced left ventricular ejection fraction (HR 2.7, P < 0.001), elevated C-reactive protein (HR 1.8, P = 0.012), and chronic renal failure (HR 2.8, P = 0.001) as independent predictors of long-term mortality.
The EuroSCORE, which is routinely used to estimate the perioperative risk of patients undergoing CABG, also predicts short- and long-term prognosis of patients undergoing MV-PCI. The observed mortality of patients undergoing MV-PCI seems to be much lower than the estimated mortality of CABG.
目的/方法：多血管冠状动脉疾病（CAD）患者的治疗一直是近期临床研究的重点，质疑理想的治疗方法。比较冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的随机试验迄今为止仅包括少数筛选患者。因此，我们分析了 679 例连续“所有患者”的资料，这些患者至少在 2 个主要血管中接受了 PCI。使用 EuroSCORE 计算 CABG 的预期院内死亡率，并与院内和长期随访期间的观察死亡率进行比较。
患者患有 2.5 +/- 0.6 个病变血管，2.8 +/- 1.0 个病变进行了支架置入（32%的患者接受了至少 1 个药物洗脱支架[DES]；20%的病变接受了 DES 治疗）。47%的患者因急性冠状动脉综合征（ACS）接受治疗（N = 176 例 ST 段抬高型心肌梗死[STEMI]；N = 140 例非 ST 段抬高型心肌梗死[NSTEMI]）。ACS 患者的 EuroSCORE 明显高于稳定型患者（logistic：STEMI 16.3 +/- 17.2；NSTEMI 13.6 +/- 13.0；稳定型 CAD 3.9 +/- 4.2）。观察到的院内死亡率（STEMI 13.0%；NSTEMI 2.9%；稳定型 CAD 1.7%，P < 0.001）远低于估计的 30 天死亡率。Cox 回归分析确定了升高的 logistic EuroSCORE（每四分位间距 HR 2.7，P = 0.003）、严重降低的左心室射血分数（HR 2.7，P < 0.001）、升高的 C 反应蛋白（HR 1.8，P = 0.012）和慢性肾功能衰竭（HR 2.8，P = 0.001）作为长期死亡率的独立预测因子。
常规用于估计接受 CABG 患者围手术期风险的 EuroSCORE 也预测了接受 MV-PCI 患者的短期和长期预后。接受 MV-PCI 的患者的观察死亡率似乎远低于 CABG 的估计死亡率。
