Venkitachalam Lakshmi, Kip Kevin E, Mulukutla Suresh R, Selzer Faith, Laskey Warren, Slater James, Cohen Howard A, Wilensky Robert L, Williams David O, Marroquin Oscar C, Sutton-Tyrrell Kim, Bunker Clareann H, Kelsey Sheryl F
Cardiovascular Institute, Department of Medicine, School of Medicine, Graduate School of Public Health, University of Pittsburgh, PA, USA.
Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):607-15. doi: 10.1161/CIRCOUTCOMES.109.869131. Epub 2009 Oct 13.
Percutaneous coronary intervention (PCI) has witnessed rapid technological advancements, resulting in improved safety and effectiveness over time. Little, however, is known about the temporal impact on patient-reported symptoms and quality of life after PCI.
Temporal trends in post-PCI symptoms were analyzed using 8879 consecutive patients enrolled in the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry (wave 1: 1997 [bare metal stents], wave 2: 1999 [uniform use of stents], wave 3: 2001 [brachytherapy], wave 4, 5: 2004, 2006 [drug eluting stents]). Patients undergoing PCI in the recent waves were older and more often reported comorbidities. However, fewer patients across the waves reported post-PCI angina at one year (wave 1 to 5: 24%, 23%, 18%, 20%, 20%; P(trend)<0.001). The lower risk of angina in recent waves was explained by patient characteristics including use of antianginal medications at discharge (relative risk [95% CI] for waves 2, 3, 4 versus 1: 1.0 [0.9 to 1.2], 0.9 [0.7 to 1.1], 1.0 [0.8 to 1.3], 0.9 [0.7 to 1.1]). Similar trend was seen in the average quality of life scores over time (adjusted mean score for waves 1 to 5: 6.2, 6.5, 6.6 and 6.6; P(trend)=0.01). Other factors associated with angina at 1 year included younger age, female gender, prior revascularization, need for repeat PCI, and hospitalization for myocardial infarction over 1 year.
Favorable temporal trends are seen in patient-reported symptoms after PCI in routine clinical practice. Specific subgroups, however, remain at risk for symptoms at 1 year and thus warrant closer attention.
经皮冠状动脉介入治疗（PCI）技术发展迅速，随着时间推移安全性和有效性均有所提高。然而，对于PCI术后患者报告的症状及生活质量的时间影响知之甚少。
使用美国国立心肺血液研究所资助的动态注册研究中连续纳入的8879例患者，分析PCI术后症状的时间趋势（第1波：1997年[裸金属支架]，第2波：1999年[统一使用支架]，第3波：2001年[近距离放射治疗]，第4、5波：2004年、2006年[药物洗脱支架]）。近期几波接受PCI的患者年龄更大，合并症报告更为常见。然而，各波中1年时报告PCI术后心绞痛的患者更少（第1至5波：24%、23%、18%、20%、20%；P（趋势）<0.001）。近期几波中心绞痛风险较低可由患者特征解释，包括出院时使用抗心绞痛药物（第2、3、4波与第1波相比的相对风险[95%CI]：1.0[0.9至1.2]、0.9[0.7至1.1]、1.0[0.8至1.3]、0.9[0.7至1.1]）。随着时间推移，平均生活质量评分也呈现类似趋势（第1至5波的调整后平均评分：6.2、6.5、6.6和6.6；P（趋势）=0.01）。1年时与心绞痛相关的其他因素包括年轻、女性、既往血运重建、需要重复PCI以及1年以上因心肌梗死住院。
在常规临床实践中，PCI术后患者报告的症状呈现出有利的时间趋势。然而，特定亚组在1年时仍有症状风险，因此需要密切关注。
