Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Catheter Cardiovasc Interv. 2013 Jan 1;81(1):E1-8. doi: 10.1002/ccd.24442. Epub 2012 Nov 8.
To determine the role of percutaneous coronary intervention (PCI) and its impact on mortality in coronary artery disease (CAD).
It's unclear whether PCI provides benefit in patients with CAD outside of acute settings. We sought to determine the role of PCI and its effect on mortality in patients with similar entry criteria to prior RCTs and compare outcomes with medical treatment.
Using institutional diagnostic catheterization database of consecutive patients undergoing coronary angiography from 1/2004 to 1/2010, we examined records for patients with a positive stress test and >70% coronary stenosis or symptoms of angina and >80% coronary stenosis. We excluded those with acute coronary syndromes, low ejection fraction (EF), history of CABG, and CABG following index catheterization. We stratified patients by treatment and performed unadjusted and propensity matched analyses. The outcome was all-cause mortality obtained from the social security death index.
We identified 3,375 patients using study inclusion criteria. Mean age was 65 ± 11 years and 69% (n = 2,332) were men. Mean EF was 55% ± 8%. In the unadjusted cohort, 1,265 patients received medical management and 2,110 received PCI. The unadjusted analysis revealed significantly better survival in PCI patients (P < 0.0001) (HR: 0.51; 95% confidence interval (CI), 0.41-0.63). Propensity matching was performed for 1,580 patients and analysis showed better survival among patients receiving PCI (0 = 0.04) (HR: 0.74; 95% CI, 0.55-0.98). PCI continued to show better survival after excluding patients with malignancy (P = 0.03) and unstable angina (P = 0.007).
This single center registry analysis demonstrated better survival in stable CAD patients undergoing PCI compared to medical management alone. These data suggest there may be a benefit of PCI beyond symptom relief. Future randomized trials are needed to further understand the role of PCI in broader patient populations.
确定经皮冠状动脉介入治疗（PCI）在冠状动脉疾病（CAD）中的作用及其对死亡率的影响。
目前尚不清楚 PCI 是否能为急性发作以外的 CAD 患者带来益处。我们试图确定 PCI 在与先前 RCT 具有相似纳入标准的 CAD 患者中的作用及其对死亡率的影响，并将其与药物治疗的结果进行比较。
我们使用机构诊断性冠状动脉造影数据库，对 2004 年 1 月至 2010 年 1 月期间连续接受冠状动脉造影的患者进行记录检查，纳入标准为应激试验阳性且存在 >70%的冠状动脉狭窄或心绞痛症状且 >80%的冠状动脉狭窄。我们排除了急性冠状动脉综合征、射血分数（EF）低、冠状动脉旁路移植术（CABG）病史和指数导管检查后的 CABG 患者。我们按治疗方法对患者进行分层，并进行了未调整和倾向评分匹配分析。主要终点是全因死亡率，从社会安全死亡指数中获得。
我们使用研究纳入标准识别了 3375 名患者。平均年龄为 65 ± 11 岁，69%（n = 2332）为男性。平均 EF 为 55% ± 8%。在未调整的队列中，1265 名患者接受药物治疗，2110 名患者接受 PCI。未调整分析显示 PCI 患者的生存显著改善（P < 0.0001）（HR：0.51；95%置信区间（CI）：0.41-0.63）。对 1580 名患者进行了倾向评分匹配分析，结果显示 PCI 患者的生存更好（0 = 0.04）（HR：0.74；95%CI：0.55-0.98）。排除恶性肿瘤（P = 0.03）和不稳定型心绞痛（P = 0.007）患者后，PCI 仍显示出更好的生存获益。
这项单中心登记研究分析表明，与单独药物治疗相比，PCI 可使稳定型 CAD 患者的生存率提高。这些数据表明，PCI 可能除了缓解症状之外还有其他益处。需要进一步开展随机临床试验以更深入了解 PCI 在更广泛患者人群中的作用。
