Penn State Hershey College of Medicine, 600 Centerview Drive, Hershey, PA 17033, USA.
Circ Cardiovasc Interv. 2011 Oct 1;4(5):413-21. doi: 10.1161/CIRCINTERVENTIONS.111.963058. Epub 2011 Oct 4.
The impact of incomplete revascularization (IR) on adverse outcomes after percutaneous coronary intervention remains inconclusive, and few studies have examined mortality during follow-ups longer than 5 years. The objective of this study is to test the hypothesis that IR is associated with higher risk of long-term (8-year) mortality after stenting for multivessel coronary disease.
A total of 13 016 patients with multivessel disease who had undergone stenting procedures with bare metal stents in 1999 to 2000 were identified in the New York State's Percutaneous Coronary Intervention Reporting System. A logistic regression model was fit to predict the probability of achieving complete revascularization (CR) in these patients using baseline risk factors; then, the CR patients were matched to the IR patients with similar likelihoods of achieving CR. Each patient's vital status was followed through 2007 using the National Death Index, and the difference in long-term mortality between IR and CR was compared. It was found that CR was achieved in 29.2% (3803) of the patients. For the 3803 pair-matched patients, the respective 8-year survival rates were 80.8% and 78.5% for CR and IR (P=0.04), respectively. The risk of death was marginally significantly higher for IR (hazard ratio=1.12; 95% confidence interval, 1.01-1.26, P=0.04). The 95% bootstrap confidence interval for the hazard ratio was 0.98 to 1.32.
IR may be associated with higher risk of long-term mortality after stenting with BMS in patients with multivessel disease. More prospective studies are needed to further test this association.
经皮冠状动脉介入治疗后不完全血运重建（IR）对不良结局的影响仍不确定，很少有研究在随访时间超过 5 年的情况下检查死亡率。本研究旨在检验以下假设：在多支血管疾病患者中，与支架置入后接受 BMS 治疗相比，IR 与长期（8 年）死亡率升高相关。
在纽约州经皮冠状动脉介入治疗报告系统中，共确定了 1999 年至 2000 年期间 13016 例接受裸金属支架置入术治疗多支血管疾病的患者。使用基线风险因素拟合逻辑回归模型，预测这些患者实现完全血运重建（CR）的概率；然后，将 CR 患者与具有相似实现 CR 可能性的 IR 患者相匹配。通过国家死亡指数，在 2007 年之前对每位患者的生存状况进行随访，并比较 IR 与 CR 之间的长期死亡率差异。结果发现，29.2%（3803 例）的患者实现了 CR。在 3803 对配对患者中，CR 和 IR 的 8 年生存率分别为 80.8%和 78.5%（P=0.04）。IR 的死亡风险略高（风险比=1.12；95%置信区间，1.01-1.26，P=0.04）。风险比的 95%自举置信区间为 0.98 至 1.32。
在多支血管疾病患者中，与接受 BMS 治疗相比，IR 可能与支架置入后长期死亡率升高相关。需要更多的前瞻性研究来进一步检验这种关联。
