Harada Mikiko, Miura Takashi, Kobayashi Takahiro, Kobayashi Hideki, Kobayashi Masanori, Nakajima Hiroyuki, Kimura Hikaru, Akanuma Hiroshi, Mawatari Eiichiro, Sato Toshio, Hotta Shoji, Kamiyoshi Yuichi, Maruyama Takuya, Watanabe Noboru, Eisawa Takayuki, Hashizume Naoto, Ebisawa Soichiro, Miyashita Yusuke, Ikeda Uichi
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Nagano Prefectural Suzaka Hospital, Nagano, Japan.
Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
Int J Cardiol. 2017 Mar 1;230:413-419. doi: 10.1016/j.ijcard.2016.12.093. Epub 2016 Dec 21.
Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (≥75years old) with multi-vessel CAD.
The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke).
Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p<0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29-4.80; p=0.007, HR, 0.40; 95% CI, 0.20-0.77; p=0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p=0.015).
Even in elderly patients over 75years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.
既往报道显示，经皮冠状动脉介入治疗（PCI）实现完全血运重建（CR）可减少缺血事件。然而，对于PCI实现CR在老年多支冠状动脉疾病（CAD）患者中的疗效知之甚少。我们评估了CR-PCI在老年（≥75岁）多支CAD患者中的1年有效性。
信浓注册研究是一项前瞻性、观察性、多中心、纳入所有患者的队列研究，已纳入1923例患者。我们从该注册研究中招募了322例老年多支CAD患者。主要终点是主要不良心血管事件（[MACE]：全因死亡率、心肌梗死和中风）。
在322例老年多支CAD患者中，165例（51.2%）接受了CR，157例（48.8%）接受了不完全血运重建（ICR）。44例（13.7%）患者发生了MACE。生存分析显示，CR组的MACE发生率显著低于ICR组（分别为7.4%和21.1%，p<0.001）。在对年龄、性别和急性冠状动脉综合征（ACS）进行多变量Cox比例风险分析时，ACS和CR是MACE的独立预测因素（风险比[HR]分别为2.49；95%置信区间[CI]为1.29 - 4.80；p = 0.007，HR为0.40；95%CI为0.20 - 0.77；p = 0.007）。在按年龄、性别、既往心力衰竭、既往颅内出血、ACS和体重指数进行倾向评分匹配后，CR组的MACE发生率显著低于ICR组（分别为7.2%和18.4%，p = 0.015）。
即使在75岁以上的老年多支CAD患者中，CR-PCI似乎也能抑制中期缺血事件。
