Reed Grant W, Masri Ahmad, Griffin Brian P, Kapadia Samir R, Ellis Stephen G, Desai Milind Y
From the Department of Cardiovascular Medicine, Center for Radiation Heart Disease, Cleveland Clinic, OH.
Circ Cardiovasc Interv. 2016 Jun;9(6). doi: 10.1161/CIRCINTERVENTIONS.115.003483.
The incidence and predictors of long-term mortality after percutaneous coronary intervention (PCI) for radiation-associated coronary artery disease are unknown.
In this observational study of 314 patients (age, 65.2±11.4 years; 233 [74%] women) treated with PCI, 157 patients with previous external beam radiation therapy (XRT) were matched 1:1 with 157 comparison patients with atherosclerotic coronary artery disease without previous XRT, based on age, sex, lesion artery, and PCI type. The primary end point was all-cause mortality, and the secondary end point was cardiovascular mortality. After follow-up of 6.6±5.5 years, there were 101 deaths; 59 in the XRT group and 42 in the comparison group (P=0.04). On Cox proportional hazards multivariable survival analysis, previous XRT remained an independent predictor of all-cause mortality (hazard ratio [HR] 1.85; 95% confidence interval [CI], 1.21-2.85; P=0.004) and cardiovascular mortality (HR, 1.70; 95% CI, 1.06-2.89; P=0.03). Additional independent predictors of increased all-cause mortality included balloon angioplasty or bare-metal stent placement compared with drug-eluting stent placement (HR, 2.50; 95% CI, 1.61-3.97; P<0.0001), SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score of ≥11 (the sample median; HR, 1.99; 95% CI, 1.32-3.04; P<0.001), New York Heart Association functional class ≥3 (HR, 1.83; 95% CI, 1.15-2.91; P=0.012), history of smoking (HR, 1.88; 95% CI, 1.10-3.09; P=0.022), and age ≥65 years (HR, 1.70; 95% CI, 1.07-2.07; P=0.024).
Compared with patients with typical atherosclerotic coronary artery disease, patients with radiation-associated coronary artery disease are at higher risk for mortality after PCI. Previous XRT exposure is independently associated with increased all-cause and cardiovascular mortality in patients treated with PCI.
经皮冠状动脉介入治疗（PCI）后，放射性相关冠状动脉疾病的长期死亡率及其预测因素尚不清楚。
在这项对314例接受PCI治疗患者（年龄65.2±11.4岁；233例[74%]为女性）的观察性研究中，157例曾接受体外放射治疗（XRT）的患者与157例无XRT史的动脉粥样硬化性冠状动脉疾病对照患者，根据年龄、性别、病变血管和PCI类型进行1:1匹配。主要终点为全因死亡率，次要终点为心血管死亡率。随访6.6±5.5年后，共有101例死亡；XRT组59例，对照组42例（P=0.04）。在Cox比例风险多变量生存分析中，既往XRT仍然是全因死亡率（风险比[HR]1.85；95%置信区间[CI]，1.21-2.85；P=0.004）和心血管死亡率（HR，1.70；95%CI，1.06-2.89；P=0.03）的独立预测因素。全因死亡率增加的其他独立预测因素包括与药物洗脱支架置入相比的球囊血管成形术或裸金属支架置入（HR，2.50；95%CI，1.61-3.97；P<0.0001）、SYNTAX（紫杉醇洗脱支架与心脏手术协同作用）评分≥11（样本中位数；HR，1.99；95%CI，1.32-3.04；P<0.001）、纽约心脏协会心功能分级≥3（HR，1.83；95%CI，1.15-2.91；P=0.012）、吸烟史（HR，1.88；95%CI，1.10-3.09；P=0.022）和年龄≥65岁（HR，1.70；95%CI，1.07-2.07；P=0.024）。
与典型动脉粥样硬化性冠状动脉疾病患者相比，放射性相关冠状动脉疾病患者PCI后死亡风险更高。既往接受XRT与PCI治疗患者的全因死亡率和心血管死亡率增加独立相关。
