Department of Special Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Rd, 100037 Beijing, China.
Department of Special Care Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Rd, 100037 Beijing, China.
Semin Arthritis Rheum. 2017 Oct;47(2):247-252. doi: 10.1016/j.semarthrit.2017.03.009. Epub 2017 Mar 24.
Coronary artery involvement significantly increases mortality of patients with Takayasu arteritis (TA); however, the optimal revascularization strategy for this condition has not been established. We aimed to compare the long-term outcomes of TA patients with coronary artery involvement treated with coronary artery bypass grafting (CABG) and percutaneous coronary intervention with stenting (PCI).
Data from 46 TA patients with coronary artery involvement were analyzed according to their revascularization strategies. The resulting events included myocardial infarction, repeated revascularization, cardiac death, and the major adverse cardiac events (MACE), which is a combination of the former events.
The risk of MACE was significantly higher in the PCI group than in the CABG group during a median of 41.0 months follow-up (P < 0.001), especially in those who underwent revascularization at the active stage of TA (P = 0.001), whereas no difference was found between PCI and CABG groups in patients who underwent revascularization at the stable stage of TA (P = 0.138). The incidence of MACE was higher in TA patients at the active stage than those at the stable stage in all patients (P < 0.001). For patients at the active stage, the risk of MACE was significantly lower in patients with than those without usage of prednisone (P = 0.028); while no difference was found between patients who were stable not requiring prednisone and patients who were stable on prednisone (P = 0.525).
With regard to MACE, CABG is superior to PCI despite medical therapy in TA patients with coronary artery involvement. In TA patients at the stable stage, PCI is similar with CABG in prognosis. For patients at the active stage, if emergency revascularization is necessary, CABG is ideal; if not, receiving medical therapy until disease remission and then undergoing PCI may be an alternative choice of CABG.
冠状动脉受累显著增加 Takayasu 动脉炎（TA）患者的死亡率；然而，该疾病的最佳血运重建策略尚未建立。我们旨在比较经冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）治疗有冠状动脉受累的 TA 患者的长期预后。
根据血运重建策略，对 46 例有冠状动脉受累的 TA 患者的数据进行分析。结果事件包括心肌梗死、再次血运重建、心脏死亡和主要不良心脏事件（MACE），即前者的组合。
在中位 41.0 个月的随访中，PCI 组的 MACE 风险明显高于 CABG 组（P<0.001），尤其是在 TA 活动期进行血运重建的患者中（P=0.001），而在 TA 稳定期进行血运重建的患者中，PCI 组与 CABG 组之间无差异（P=0.138）。在所有患者中，TA 活动期患者的 MACE 发生率高于稳定期患者（P<0.001）。对于活动期患者，与未使用泼尼松的患者相比，使用泼尼松的患者的 MACE 风险显著降低（P=0.028）；而在无需泼尼松的稳定患者和泼尼松稳定的患者之间，无差异（P=0.525）。
对于 MACE，尽管有药物治疗，CABG 优于 PCI，在有冠状动脉受累的 TA 患者中。在 TA 稳定期患者中，PCI 与 CABG 在预后方面相似。对于活动期患者，如果需要紧急血运重建，CABG 是理想的；如果不需要，则在疾病缓解后接受药物治疗，然后进行 PCI 可能是 CABG 的替代选择。
