无保护左主干冠状动脉疾病患者血运重建后的长期预后

[Long-term outcomes of patients with unprotected left main coronary artery disease post revascularization].

作者信息

Yu Xianpeng, Lyu Shuzheng, He Jiqiang, Gao Yuechun, Luo Yawei, Song Xiantao, Yuan Fei, Huang Fangjiong, Gu Chengxiong, Chen Fang

机构信息

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; Email:

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2015 May;43(5):399-403.

PMID:26419983

Abstract

OBJECTIVE

To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease (ULMCA) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG).

METHODS

Consecutive patients with ULMCA (defined as stenosis ≥ 50%) undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled. The follow-up period extended through August 2013. The end points of the study were death, cardiac death, repeat revascularization, myocardial infarction (MI), stroke, the composite of cardiac death, MI or stroke and MACCE (major adverse cardiac and cerebrovascular events, the composite of cardiac death, MI, stroke or repeat revascularization).

RESULTS

From January 2003 to July 2009, 922 ULMCA patients were enrolled in this study (465 PCI patients, and 457 CABG patients). The median follow-up was 7.1 years (interquartile range 5.3 to 8.2 years). The crude relative risk was as follows: overall death rate (13.0% (41/465) vs. 22.1% (72/457), P = 0.009), stroke rate (5.8% (11/465) vs. CABG 18.9% (46/457), P < 0.001) were significantly lower whereas the rate of repeat revascularization (32.3% (110/465) vs. CABG 19.2% (58/457), P < 0.001) was significantly higher in PCI group than in CABG group. MI rate was similar between PCI and CABG group (13.9% (33/465) vs. 6.7% (26/457), P = 0.196). MACCE rate was also similar between the 2 groups (42.9% (145/465) vs. 42.5% (142/457), P = 0.122). After multivariate adjusting, there was no significant difference in rates of death, MI and a composite of serious outcomes (cardiac death, MI, or stroke) between the 2 groups. Rates of MACCE were significantly higher in the PCI group (P = 0.009) due to increased rate of repeat revascularization (P < 0.001). However, stroke rate was still significantly higher in CABG group (P = 0.001) after multivariate adjusting.

CONCLUSION

During a follow-up up to 8.2 years, the survival rate is similar between the PCI and the CABG group in patients with ULMCA disease. The rate of repeat revascularization is significantly higher and stroke rate is significantly lower in the PCI group compared to CABG group.

摘要

目的

比较连续接受药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的无保护左主干冠状动脉疾病（ULMCA）患者的长期真实世界结局。

方法

纳入2003年1月至2009年7月在北京安贞医院接受DES植入或CABG的连续ULMCA患者（定义为狭窄≥50%）。随访期至2013年8月。研究终点为死亡、心源性死亡、再次血运重建、心肌梗死（MI）、卒中、心源性死亡、MI或卒中的复合终点以及主要不良心脑血管事件（MACCE，心源性死亡、MI、卒中或再次血运重建的复合终点）。

结果

2003年1月至2009年7月，922例ULMCA患者纳入本研究（465例PCI患者和457例CABG患者）。中位随访时间为7.1年（四分位间距5.3至8.2年）。粗略相对风险如下：总体死亡率（13.0%（41/465）对22.1%（72/457），P = 0.009）、卒中率（5.8%（11/465）对CABG组的18.9%（46/457），P < 0.001）在PCI组显著更低，而再次血运重建率（32.3%（110/465）对CABG组的19.2%（58/457），P < 0.001）在PCI组显著高于CABG组。PCI组和CABG组的MI率相似（13.9%（33/465）对6.7%（26/457），P = 0.196）。两组的MACCE率也相似（42.9%（145/465）对42.5%（142/457），P = 0.122）。多变量调整后，两组在死亡、MI和严重结局（心源性死亡、MI或卒中）复合终点的发生率上无显著差异。PCI组的MACCE率显著更高（P = 0.009），原因是再次血运重建率增加（P < 0.001）。然而，多变量调整后CABG组的卒中率仍显著更高（P = 0.001）。