Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
Scand Cardiovasc J. 2010 Oct;44(5):279-88. doi: 10.3109/14017431003698531. Epub 2010 Jun 7.
To evaluate the influence of competing risk (CR) non-cardiac death during long-term follow-up of revascularized patients on the interpretation of the cardiac outcomes.
Retrospectively, we compared outcomes estimated with the Kaplan-Meier and the cumulative incidence function (CIF) methods after a median 10.8 years follow-up in 1,234 consecutive patients (594 CABG, 640 PCI) undergoing first time non-emergent revascularization in a community cohort.
Overall 301 (24.4%) patients died (27.3% in the CABG vs. 21.7% in the PCI group, p = 0.02). The causes of death were cardiac (10.3%) and non-cardiac (14.1%). CR analysis showed a similar probability of cardiac death (CIF 0.10 (95% CI 0.092, 0.18) vs. 0.093 (0.07, 0.12)) in the CABG and PCI treated patients, respectively. The probability for acute myocardial infarction (CIF 0.12 vs. 0.16 p < 0.001), congestive heart failure (CIF 0.15 vs. 0.09 p = 0.007) in the CABG and PCI group respectively, differed. The differences were also statistically significant after multivariate adjustment for the competing risks of death. For all outcomes the Kaplan-Meier method overestimated risk estimates.
The competing risk adjusted probability for cardiac death, but not other cardiac endpoints are comparable in patients treated with either CABG or PCI after very long-term follow-up. The risk for all-cause death was mainly predicted by the occurrence of non-cardiac diseases.
评估在接受血运重建治疗的患者的长期随访中，竞争风险（CR）非心脏死亡对心脏结局解释的影响。
回顾性地，我们比较了在社区队列中 1234 例连续患者（594 例 CABG，640 例 PCI）首次非紧急血运重建后中位 10.8 年随访中，Kaplan-Meier 法和累积发生率函数（CIF）法估计的结果。
共有 301 例（24.4%）患者死亡（CABG 组为 27.3%，PCI 组为 21.7%，p = 0.02）。死亡原因包括心脏原因（10.3%）和非心脏原因（14.1%）。CR 分析显示，CABG 和 PCI 治疗患者的心脏死亡概率相似（CIF 分别为 0.10（95%CI 0.092，0.18）和 0.093（0.07，0.12））。急性心肌梗死的概率（CIF 0.12 比 0.16，p < 0.001）、充血性心力衰竭（CIF 0.15 比 0.09，p = 0.007）在 CABG 和 PCI 组之间存在差异。多变量调整竞争风险死亡后，差异仍然具有统计学意义。对于所有结局，Kaplan-Meier 法高估了风险估计。
在非常长的随访后，接受 CABG 或 PCI 治疗的患者，竞争风险调整后的心脏死亡概率，但不是其他心脏终点，具有可比性。全因死亡的风险主要由非心脏疾病的发生预测。
