Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
JACC Cardiovasc Interv. 2010 Feb;3(2):172-9. doi: 10.1016/j.jcin.2009.11.013.
We sought to determine the characteristics, outcomes, and temporal trends among patients undergoing percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) from a single-center registry.
There is controversy regarding the generalizability of the findings from randomized trials of PCI for stable CAD to daily practice. An important perspective on the significance of the trial results can be achieved by clearly documenting past and present practice of PCI.
This was a retrospective analysis of 8,912 consecutive patients undergoing elective PCI from 1979 through 2006 at a tertiary referral center. Clinical, angiographic, and procedural characteristics as well as in-hospital and long-term outcomes were measured in patients grouped into 4 eras depending on the dominant interventional strategy of that time: percutaneous transluminal coronary angioplasty, early stent, bare-metal stent, and drug-eluting stent.
Procedural success rates have improved (81%, 92%, 96%, and 97%, respectively, p < 0.001), and in-hospital mortality has decreased significantly (1.0%, 0.8%, 0.1%, and 0.1%, respectively, p < 0.001) over time. Kaplan-Meier estimates of mortality at 4 years were 11%, 13%, 10%, and 10%, respectively (p = 0.4). The 1-year target lesion revascularization rates in the 4 groups were 29%, 26%, 13%, and 8%, respectively (p < 0.001).
Procedural success rates in contemporary practice of PCI for stable CAD are excellent with very low in-hospital mortality. Introduction of drug-eluting stents has reduced target lesion revascularization but not mortality among all comers. Outcomes similar to that observed in recent clinical trials are being achieved in routine clinical practice.
我们旨在从单中心注册研究中确定经皮冠状动脉介入治疗（PCI）稳定型冠状动脉疾病（CAD）患者的特征、结局和时间趋势。
随机 PCI 治疗稳定 CAD 试验结果的普遍性存在争议，对 PCI 实践的过去和现在进行明确记录可以更清楚地了解试验结果的重要意义。
这是对 1979 年至 2006 年在一家三级转诊中心行择期 PCI 的 8912 例连续患者进行的回顾性分析。根据当时主导的介入策略，将患者分为 4 个时期，测量临床、血管造影和手术特征以及住院和长期结局：经皮腔内冠状动脉成形术、早期支架、裸金属支架和药物洗脱支架。
手术成功率不断提高（分别为 81%、92%、96%和 97%，p < 0.001），住院死亡率显著下降（分别为 1.0%、0.8%、0.1%和 0.1%，p < 0.001）。4 年时死亡率的 Kaplan-Meier 估计值分别为 11%、13%、10%和 10%（p = 0.4）。4 组的 1 年靶病变血运重建率分别为 29%、26%、13%和 8%（p < 0.001）。
在稳定型 CAD 的现代 PCI 实践中，手术成功率非常高，住院死亡率极低。药物洗脱支架的应用降低了所有患者的靶病变血运重建率，但没有降低死亡率。在常规临床实践中，正在取得与最近临床试验相似的结果。
