Kang Se Hun, Ahn Jung-Min, Lee Cheol Hyun, Lee Pil Hyung, Kang Soo-Jin, Lee Seung-Whan, Kim Young-Hak, Lee Cheol Whan, Park Seong-Wook, Park Duk-Woo, Park Seung-Jung
From the Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea (S.H.K.); and Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.-M.A., C.H.L., P.H.L., S.-J.K., S.-W.L., Y.-H.K., C.W.L., S.-W.P., D.-W.P., S.-J.P.).
Circ Cardiovasc Interv. 2017 Jul;10(7). doi: 10.1161/CIRCINTERVENTIONS.116.004988.
Identifying predictive factors for major cardiovascular events and death in patients with unprotected left main coronary artery disease is of great clinical value for risk stratification and possible guidance for tailored preventive strategies.
The Interventional Research Incorporation Society-Left MAIN Revascularization registry included 5795 patients with unprotected left main coronary artery disease (percutaneous coronary intervention, n=2850; coronary-artery bypass grafting, n=2337; medication alone, n=608). We analyzed the incidence and independent predictors of major adverse cardiac and cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat revascularization) and all-cause mortality in each treatment stratum. During follow-up (median, 4.3 years), the rates of MACCE and death were substantially higher in the medical group than in the percutaneous coronary intervention and coronary-artery bypass grafting groups (<0.001). In the percutaneous coronary intervention group, the 3 strongest predictors for MACCE were chronic renal failure, old age (≥65 years), and previous heart failure; those for all-cause mortality were chronic renal failure, old age, and low ejection fraction. In the coronary-artery bypass grafting group, old age, chronic renal failure, and low ejection fraction were the 3 strongest predictors of MACCE and death. In the medication group, old age, low ejection fraction, and diabetes mellitus were the 3 strongest predictors of MACCE and death.
Among patients with unprotected left main coronary artery disease, the key clinical predictors for MACCE and death were generally similar regardless of index treatment. This study provides effect estimates for clinically relevant predictors of long-term clinical outcomes in real-world left main coronary artery patients, providing possible guidance for tailored preventive strategies.
URL: https://clinicaltrials.gov. Unique identifier: NCT01341327.
识别无保护左主干冠状动脉疾病患者发生主要心血管事件和死亡的预测因素，对于风险分层及制定针对性预防策略具有重要临床价值。
介入研究协会左主干血运重建注册研究纳入了5795例无保护左主干冠状动脉疾病患者（经皮冠状动脉介入治疗，n = 2850；冠状动脉旁路移植术，n = 2337；单纯药物治疗，n = 608）。我们分析了各治疗组中主要不良心脑血管事件（MACCE，包括死亡、心肌梗死、卒中或再次血运重建）及全因死亡率的发生率和独立预测因素。随访期间（中位时间4.3年），药物治疗组的MACCE和死亡率显著高于经皮冠状动脉介入治疗组和冠状动脉旁路移植术组（<0.001）。在经皮冠状动脉介入治疗组中，MACCE的3个最强预测因素为慢性肾功能衰竭、老年（≥65岁）和既往心力衰竭；全因死亡率的预测因素为慢性肾功能衰竭、老年和低射血分数。在冠状动脉旁路移植术组中，老年、慢性肾功能衰竭和低射血分数是MACCE和死亡的3个最强预测因素。在药物治疗组中，老年、低射血分数和糖尿病是MACCE和死亡的3个最强预测因素。
在无保护左主干冠状动脉疾病患者中，无论初始治疗方式如何，MACCE和死亡的关键临床预测因素通常相似。本研究为真实世界中左主干冠状动脉疾病患者长期临床结局的临床相关预测因素提供了效应估计，为制定针对性预防策略提供了可能的指导。
