CHU Sart Tilman, Liège, Belgium.
EuroIntervention. 2011 Feb;6(7):838-45. doi: 10.4244/EIJV6I7A144.
We sought to evaluate the prognostic impact of age on the procedural results and subsequent clinical outcomes in patients with multivessel disease (MVD) treated either by coronary artery bypass surgery (CABG) or by percutaneous coronary intervention (PCI) with or without drug eluting stents, based on data of the Arterial Revascularisation Therapies Study (ARTS) part I and part II. The potential influence of age in determining the most appropriate revascularisation strategy for patients with MVD is largely unknown.
Three year clinical outcome of ARTS I patients randomised to PCI with bare metal stent (BMS) (n= 600) or CABG (n= 605), and matched patients treated by PCI with sirolimus-eluting stents (SES) in ARTS II (n= 607) were reviewed according to four age quartiles. Endpoints were measured in terms of major adverse cardiac and cerebrovascular events MACCE) during hospital stay and up to three years. The frequency of female, diabetes, hypertension, peripheral vascular disease, pulmonary disease, as well as lesion complexity increased with age. At three years, MACCE free survival was comparable between patients treated by CABG or SES PCI, regardless of age quartile. The incidence of MACCE was higher among ARTS I BMS treated patients in all but the second age quartile. This was primarily related to a higher need for repeat revascularisation among BMS treated patients. However, age, which emerged as a strong independent predictor of MACCE following CABG (p<0.005), was not predictive of adverse events following PCI. Conversely, diabetes was the strongest independent predictor of MACCE among PCI treated patients (p<0.02), but didn't affect three-year outcomes following CABG.
Age seems to influence the CABG outcome in-hospital but not PCI. PCI-SES could offer lower immediate risk in patients with MVD and comparable long-term outcome as CABG especially in older patients. The worst outcome of PCI-BMS group is primarily related to the need for repeat revascularisation. Diabetes is the most important predictor of MACCE following PCI.
我们旨在评估年龄对多血管疾病（MVD）患者接受冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）联合或不联合药物洗脱支架治疗的手术结果和后续临床结局的预后影响，该研究基于动脉再血管化治疗研究（ARTS）I 部分和 II 部分的数据。年龄对确定 MVD 患者最合适的血运重建策略的潜在影响在很大程度上是未知的。
根据四个年龄四分位，回顾 ARTS I 部分中随机接受裸金属支架（BMS）PCI（n=600）或 CABG（n=605）治疗的患者和 ARTS II 部分中接受西罗莫司洗脱支架（SES）PCI 治疗的匹配患者（n=607）的 3 年临床结局。终点是住院期间和 3 年内主要不良心脏和脑血管事件（MACCE）的发生率。女性、糖尿病、高血压、外周血管疾病、肺部疾病以及病变复杂性随着年龄的增加而增加。在 3 年时，无论年龄四分位如何，接受 CABG 或 SES PCI 治疗的患者的 MACCE 无事件生存率相似。在所有但第二个年龄四分位中，ARTS I BMS 治疗患者的 MACCE 发生率更高。这主要与 BMS 治疗患者需要更多的再次血运重建有关。然而，年龄是 CABG 后 MACCE 的一个强有力的独立预测因素（p<0.005），但不是 PCI 后不良事件的预测因素。相反，糖尿病是 PCI 治疗患者 MACCE 的最强独立预测因素（p<0.02），但不影响 CABG 后的 3 年结局。
年龄似乎会影响 CABG 的住院期间结果，但不会影响 PCI。在 MVD 患者中，PCI-SES 可能会带来较低的即刻风险，与 CABG 相比，其长期结果相当，尤其是在老年患者中。PCI-BMS 组最差的结果主要与需要再次血运重建有关。糖尿病是 PCI 后 MACCE 的最重要预测因素。
