多支血管病变患者药物洗脱支架置入术后完全与不完全血运重建的长期结果。

Long-term outcomes of complete versus incomplete revascularization after drug-eluting stent implantation in patients with multivessel coronary disease.

机构信息

Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

出版信息

Catheter Cardiovasc Interv. 2013 Sep 1;82(3):343-9. doi: 10.1002/ccd.24799. Epub 2013 Apr 16.

DOI:10.1002/ccd.24799

PMID:23554306

Abstract

BACKGROUND

A limited number of studies on the impact of complete revascularization (CR) vs. incomplete revascularization (IR) on long-term outcomes in patients with multivessel coronary disease (MVD) in current percutaneous coronary intervention (PCI) practice have yielded inconsistent results.

METHODS

Between April 2004 and November 2010, 7,376 consecutive patients with MVD underwent PCI at the Fuwai Hospital in Beijing, China. Patients who underwent prior CABG and those who had an acute myocardial infarction (MI) within 24 hr before revascularization or presented with cardiogenic shock were excluded. Angiographic CR was defined as successful angioplasty of all diseased lesions in the major epicardial coronary vessels and their first degree side branches (diameter ≥2.5 mm), and proximal CR was defined as successful angioplasty of all diseased proximal arteries.

RESULTS

Among 7,065 patients with MVD undergoing PCI treatment, angiographic CR was performed in 1,188 patients (16.8%), and proximal CR in 2,053 patients (29.1%). The study found that either angiographic or proximal IR were associated with significantly higher estimated 3-year rate of cardiac death (2.55% vs. 1.13%, log-rank P = 0.016; and 2.70% vs. 1.43%, log-rank P = 0.024, respectively). After adjustment for differences in baseline characteristics between IR and CR patients, angiographic IR was associated with a significantly higher rate of cardiac death (adjusted hazards ratio [HR]: 2.56, 95% confidence interval [CI]: 1.03-6.41) while proximal IR was associated with a numerically higher rate of cardiac death (adjusted HR: 1.72, 95% CI: 0.93-3.17). For the subgroup of ≥2-vessel IR with total occlusion, either angiographic or proximal IR patients had significantly higher rate of cardiac death (adjusted HR: 4.25, 95% CI: 1.50-12.09; and adjusted HR: 3.02, 95% CI: 1.40-6.52, respectively).

CONCLUSION

Compared with IR, patients with CR had better clinical outcomes, supporting CR as first choice for patients with MVD.

摘要

背景

目前经皮冠状动脉介入治疗（PCI）中，仅有少数研究探讨了完全血运重建（CR）与不完全血运重建（IR）对多血管病变（MVD）患者长期结局的影响，结果并不一致。

方法

2004 年 4 月至 2010 年 11 月，在中国北京阜外医院连续纳入 7376 例 MVD 患者接受 PCI 治疗。排除既往 CABG 患者和血管成形术前 24 小时内发生急性心肌梗死（MI）或出现心源性休克的患者。血管造影 CR 定义为成功地对所有主要心外膜冠状动脉及其一级分支（直径≥2.5mm）的病变进行血管成形术，近端 CR 定义为对所有病变近端动脉的成功血管成形术。

结果

在 7065 例接受 PCI 治疗的 MVD 患者中，1188 例（16.8%）患者行血管造影 CR，2053 例（29.1%）患者行近端 CR。研究发现，无论血管造影或近端 IR，估计 3 年心脏死亡率均显著较高（2.55% vs. 1.13%，log-rank P=0.016；2.70% vs. 1.43%，log-rank P=0.024）。校正 IR 与 CR 患者之间基线特征的差异后，血管造影 IR 与心脏死亡风险显著升高相关（校正 HR：2.56，95%CI：1.03-6.41），而近端 IR 与心脏死亡风险升高相关（校正 HR：1.72，95%CI：0.93-3.17）。对于≥2 支血管 IR 伴完全闭塞亚组，血管造影或近端 IR 患者的心脏死亡率均显著升高（校正 HR：4.25，95%CI：1.50-12.09；校正 HR：3.02，95%CI：1.40-6.52）。