Song Young Bin, Lee Sang-Yeub, Hahn Joo-Yong, Choi Seung-Hyuk, Choi Jin-Ho, Lee Sang Hoon, Hong Kyung Pyo, Park Jeong Euy, Gwon Hyeon-Cheol
Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Heart Vessels. 2012 Sep;27(5):433-42. doi: 10.1007/s00380-011-0173-x. Epub 2011 Jul 16.
Limited data exist regarding the impact of complete revascularization (CR) versus incomplete revascularization (IR) on the long-term outcomes of patients with multivessel coronary artery disease (MVD) who underwent percutaneous coronary intervention with drug-eluting stents. We compared major adverse cardiac events [MACE: death, myocardial infarction (MI), or any revascularization] in 873 patients and in 255 pairs generated by propensity-score matching. CR was performed in 427 patients (48.9%) and IR in 446 (51.1%). While the amount of myocardium at risk by the APPROACH score was similar between two groups (56.0 ± 14.4 vs. 56.7 ± 16.1, p = 0.49), the SYNTAX score was lower in the CR group than in the IR group (20.7 ± 9.4 vs. 23.3 ± 10.7, p < 0.01). MACE occurred in 203 patients (23.3%) during a median follow-up of 35 months. CR was associated with a lower incidence of MACE (HR 0.64; 95% CI 0.46-0.88; p < 0.01) and revascularization (HR 0.61; 95% CI 0.42-0.90; p = 0.01), but not of death (HR 0.87; 95% CI 0.48-1.57; p = 0.64) and MI (HR 0.62; 95% CI 0.23-1.67; p = 0.35). The incidence of periprocedural MI and stent thrombosis was similar in two groups (4.7% in the CR group vs. 3.6% in the IR group, p = 0.42; 1.6 vs. 1.3%, p = 0.72, respectively). After propensity-score matching, patients with CR had fewer MACE and revascularization than those with IR. In patients with MVD, CR strategy using drug-eluting stents could reduce repeat revascularization with similar death, MI, and stent thrombosis risk compared with IR strategy.
关于完全血运重建（CR）与不完全血运重建（IR）对接受药物洗脱支架经皮冠状动脉介入治疗的多支冠状动脉疾病（MVD）患者长期预后的影响，现有数据有限。我们比较了873例患者以及倾向评分匹配产生的255对患者中的主要不良心脏事件[MACE：死亡、心肌梗死（MI）或任何血运重建]。427例患者（48.9%）进行了CR，446例患者（51.1%）进行了IR。虽然两组间根据APPROACH评分处于危险中的心肌量相似（56.0±14.4对56.7±16.1，p=0.49），但CR组的SYNTAX评分低于IR组（20.7±9.4对23.3±10.7，p<0.01）。在35个月的中位随访期内，203例患者（23.3%）发生了MACE。CR与较低的MACE发生率（HR 0.64；95%CI 0.46 - 0.88；p<0.01）和血运重建发生率（HR 0.61；95%CI 0.42 - 0.90；p = 0.01）相关，但与死亡（HR 0.87；95%CI 0.48 - 1.57；p = 0.64）和MI（HR 0.62；95%CI 0.23 - 1.67；p = 0.35）无关。两组围手术期MI和支架血栓形成的发生率相似（CR组为4.7%，IR组为3.6%，p = 0.42；分别为1.6%对1.3%，p = 0.72）。倾向评分匹配后，CR患者的MACE和血运重建比IR患者少。在MVD患者中，与IR策略相比，使用药物洗脱支架的CR策略可降低再次血运重建的发生率，且死亡、MI和支架血栓形成风险相似。
