Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Am Coll Cardiol. 2016 Jan 5;67(1):42-55. doi: 10.1016/j.jacc.2015.10.043.
There are no data available on specific causes of death from randomized trials that have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI).
The purpose of this study was to investigate specific causes of death, and its predictors, after revascularization for complex coronary disease in patients.
An independent Clinical Events Committee consisting of expert physicians who were blinded to the study treatment subclassified causes of death as cardiovascular (cardiac and vascular), noncardiovascular, or undetermined according to the trial protocol. Cardiac deaths were classified as sudden cardiac, related to myocardial infarction (MI), and other cardiac deaths.
In the randomized cohort, there were 97 deaths after CABG and 123 deaths after PCI during a 5-year follow-up. After CABG, 49.4% of deaths were cardiovascular, with the greatest cause being heart failure, arrhythmia, or other causes (24.6%), whereas after PCI, the majority of deaths were cardiovascular (67.5%) and as a result of MI (29.3%). The cumulative incidence rates of all-cause death were not significantly different between CABG and PCI (11.4% vs. 13.9%, respectively; p = 0.10), whereas there were significant differences in terms of cardiovascular (5.8% vs. 9.6%, respectively; p = 0.008) and cardiac death (5.3% vs. 9.0%, respectively; p = 0.003), which were caused primarily by a reduction in MI-related death with CABG compared with PCI (0.4% vs. 4.1%, respectively; p <0.0001). Treatment with PCI versus CABG was an independent predictor of cardiac death (hazard ratio: 1.55; 95% confidence interval: 1.09 to 2.33; p = 0.045). The difference in MI-related death was seen largely in patients with diabetes, 3-vessel disease, or high SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries) trial scores.
During a 5-year follow-up, CABG in comparison with PCI was associated with a significantly reduced rate of MI-related death, which was the leading cause of death after PCI. Treatments following PCI should target reducing post-revascularization spontaneous MI. Furthermore, secondary preventive medication remains essential in reducing events post-revascularization. (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
在比较冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的随机试验中，尚无关于具体死因的数据。
本研究旨在调查复杂冠状动脉疾病患者血运重建后的具体死因及其预测因素。
一个由专家组成的独立临床事件委员会，这些专家在研究治疗分组中对死因进行了分类，根据试验方案，死因分为心血管（心脏和血管）、非心血管或不确定。心脏性死亡分为心脏性猝死、与心肌梗死（MI）相关的死亡和其他心脏性死亡。
在随机队列中，CABG 后 5 年随访中有 97 例死亡，PCI 后有 123 例死亡。CABG 后，49.4%的死亡为心血管原因，最大的死因是心力衰竭、心律失常或其他原因（24.6%），而 PCI 后，大多数死亡为心血管原因（67.5%），主要是由于 MI（29.3%）。CABG 和 PCI 的全因死亡率无显著差异（分别为 11.4%和 13.9%；p=0.10），但心血管死亡率（分别为 5.8%和 9.6%；p=0.008）和心脏性死亡率（分别为 5.3%和 9.0%；p=0.003）有显著差异，主要是由于 CABG 降低了 MI 相关死亡率，而 PCI 则增加了这一死亡率（分别为 0.4%和 4.1%；p<0.0001）。与 CABG 相比，PCI 是心脏性死亡的独立预测因素（风险比：1.55；95%置信区间：1.09 至 2.33；p=0.045）。与 CABG 相比，MI 相关死亡率的差异主要发生在糖尿病、3 支血管疾病或高 SYNTAX（TAXUS 药物洗脱支架与冠状动脉旁路移植术治疗狭窄血管）试验评分患者中。
在 5 年随访期间，CABG 与 PCI 相比，MI 相关死亡率显著降低，这是 PCI 后死亡的主要原因。PCI 后应采取治疗措施减少再血管化后自发性 MI。此外，二级预防药物仍然是减少再血管化后事件的关键。（TAXUS 药物洗脱支架与冠状动脉旁路移植术治疗狭窄血管[SYNTAX]；NCT00114972）。
