University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Catheter Cardiovasc Interv. 2011 Apr 1;77(5):617-22. doi: 10.1002/ccd.22784.
CABG and PCI are effective means for revascularization of patients with multi-vessel coronary artery disease, but previous studies have not focused on treatment of patients that first undergo primary PCI.
Among patients enrolled in the global registry of acute coronary events (GRACE), clinical outcomes for patients presenting with STEMI treated with primary PCI were compared according to whether residual stenoses were treated medically, surgically, or with staged PCI. Clinical characteristics and data pertaining to major adverse cardiac events during hospitalization and 6 months after discharge were collected.
Of the 1,705 patients included, 1,345 (79%) patients were treated medically, 303 (18%) underwent staged PCI, and 57 (3.3%) underwent CABG following primary PCI. Hospital mortality was lowest among patients treated with staged PCI (Medical = 5.7%; PCI = 0.7%; CABG = 3.5%; P < 0.001 [PCI vs. Medical]), a finding that persisted after risk adjustment (Odds Ratio PCI vs. Medical 5 0.16, [0.04-0.68]; P 5 0.01). Six month postdischarge mortality likewise was lowest in the staged PCI group (Medical = 3.1%; PCI = 0.8%; CABG = 4.0%; P = 0.04 [PCI vs. Medical]). Patients revascularized surgically were rehospitalized less frequently (Medical = 20%; PCI = 19%; CABG = 6.3%; P < 0.05) and underwent fewer unscheduled procedures (Medical 5 9.8%; PCI = 10.0%; CABG = 0.0%; P < 0.02).
The results of this multinational registry demonstrate that hospital mortality in patients who undergo staged percutaneous revascularization of multivessel coronary disease following primary PCI is very low. Patients undergoing CABG following primary PCI are hospitalized less frequently and undergo fewer unplanned catheter-based procedures.
CABG 和 PCI 是多支冠状动脉疾病患者血运重建的有效手段，但以前的研究并未关注首先接受直接经皮冠状动脉介入治疗（PCI）的患者的治疗。
在全球急性冠状动脉事件注册（GRACE）中，根据初次 PCI 后残余狭窄是否接受药物、手术或分期 PCI 治疗，比较接受直接 PCI 治疗的 STEMI 患者的临床结局。收集住院期间和出院后 6 个月内主要不良心脏事件的临床特征和数据。
在纳入的 1705 例患者中，1345 例（79%）患者接受药物治疗，303 例（18%）接受分期 PCI，57 例（3.3%）在初次 PCI 后行 CABG。接受分期 PCI 的患者住院死亡率最低（药物治疗=5.7%；PCI=0.7%；CABG=3.5%；P<0.001[PCI 与药物治疗相比]），风险调整后仍保持这种结果（PCI 与药物治疗相比的优势比 PCI 50.16，[0.04-0.68]；P=0.01）。同样，出院后 6 个月的死亡率在分期 PCI 组最低（药物治疗=3.1%；PCI=0.8%；CABG=4.0%；P=0.04[PCI 与药物治疗相比]）。接受手术血运重建的患者再住院频率较低（药物治疗=20%；PCI=19%；CABG=6.3%；P<0.05），且接受的非计划性介入程序较少（药物治疗=9.8%；PCI=10.0%；CABG=0.0%；P<0.02）。
这项多中心注册研究的结果表明，在初次 PCI 后接受多支冠状动脉疾病分期经皮血运重建的患者的住院死亡率非常低。初次 PCI 后行 CABG 的患者住院频率较低，且接受的非计划性经皮冠状动脉介入治疗程序较少。
