Sohn Gwan Hyeop, Yang Jeong Hoon, Choi Seung-Hyuk, Song Young Bin, Hahn Joo-Yong, Choi Jin-Ho, Gwon Hyeon-Cheol, Lee Sang Hoon
Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2014 Nov;29(11):1501-6. doi: 10.3346/jkms.2014.29.11.1501. Epub 2014 Nov 4.
We aimed to investigate that complete revascularization (CR) would be associated with a decreased mortality in patients with multivessel disease (MVD) and reduced left ventricular ejection fraction (LVEF). We enrolled a total of 263 patients with MVD and LVEF <50% who had undergone percutaneous coronary intervention with drug-eluting stent between March 2003 and December 2010. We compared major adverse cardiac and cerebrovascular accident (MACCE) including all-cause death, myocardial infarction, any revascularization, and cerebrovascular accident between CR and incomplete revascularization (IR). CR was achieved in 150 patients. During median follow-up of 40 months, MACCE occurred in 52 (34.7%) patients in the CR group versus 51 (45.1%) patients in the IR group (P=0.06). After a Cox regression model with inverse-probability-of-treatment-weighting using propensity score, the incidence of MACCE of the CR group were lower than those of the IR group (34.7% vs. 45.1%; adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.95, P=0.03). The rate of all-cause death was significantly lower in patients with CR than in those with IR (adjusted HR, 0.48; 95% CI, 0.29-0.80, P<0.01). In conclusion, the achievement of CR with drug-eluting stent reduces long-term MACCE in patients with MVD and reduced LVEF.
我们旨在研究完全血运重建（CR）是否与多支血管病变（MVD）且左心室射血分数（LVEF）降低的患者死亡率降低相关。我们纳入了263例MVD且LVEF<50%的患者，这些患者在2003年3月至2010年12月期间接受了药物洗脱支架的经皮冠状动脉介入治疗。我们比较了CR组和不完全血运重建（IR）组的主要不良心脑血管事件（MACCE），包括全因死亡、心肌梗死、任何血运重建和脑血管意外。150例患者实现了CR。在40个月的中位随访期间，CR组有52例（34.7%）患者发生MACCE，而IR组有51例（45.1%）患者发生MACCE（P=0.06）。在使用倾向评分进行治疗权重逆概率的Cox回归模型分析后，CR组MACCE的发生率低于IR组（34.7%对45.1%；调整后的风险比[HR]，0.65；95%置信区间[CI]，0.44 - 0.95，P=0.03）。CR患者的全因死亡率显著低于IR患者（调整后的HR，0.48；95%CI，0.29 - 0.80，P<0.01）。总之，药物洗脱支架实现CR可降低MVD且LVEF降低患者的长期MACCE。
