Yoda Shunichi, Hori Yusuke, Hayase Misa, Mineki Takashi, Hatta Takumi, Suzuki Yasuyuki, Matsumoto Naoya, Hirayama Atsushi
Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
J Cardiol. 2018 Jan;71(1):44-51. doi: 10.1016/j.jjcc.2017.05.008. Epub 2017 Jul 18.
There is no report on correlation between early revascularization and the occurrence of major cardiac events (MCEs) except severe heart failure in Japanese patients with stable coronary artery disease (CAD). This study aimed to determine whether early revascularization affected the incidence of MCEs in Japanese patients with stable CAD.
We retrospectively investigated 3581 stable CAD patients who underwent rest Tl and stress Tc-tetrofosmin myocardial perfusion single-photon emission computed tomography (SPECT) and provided three-year-prognostic data. The endpoint was the onset of MCEs consisting of cardiac death, non-fatal myocardial infarction, and unstable angina pectoris. On the basis of estimated propensity scores, patients who underwent revascularization within the first 60 days after the SPECT and those who did not were matched in a 1:1 ratio (n=450 per group). We compared MCE rates in relation to the amount of ischemic myocardium detected with the SPECT between the two groups.
The overall incidence of MCEs was not significantly different between the early-revascularization and no-early-revascularization groups (6.7% vs. 8.7%, p=0.2598). Nevertheless, the incidence of MCEs in the patients with ≤5% ischemia was significantly higher in the early-revascularization group than in the no-early-revascularization group (5.8% vs. 0.8%, p=0.0226). In contrast, the incidence of MCEs in the patients with >10% ischemia was significantly lower in the early-revascularization group than in the no-early-revascularization group (7.0% vs. 16.8%, p=0.0036). The incidence of MCEs in the patients with 6-10% ischemia, however, was not significantly different between the early-revascularization and no-early-revascularization groups (6.9% vs. 4.1%, p=0.3235).
Early revascularization possibly leads to the occurrence of MCEs related to the treatment procedure but may be a therapeutic strategy leading to improvement in prognosis in patients with moderate to severe ischemia.
在日本稳定型冠状动脉疾病（CAD）患者中，除严重心力衰竭外，尚无关于早期血运重建与主要心脏事件（MCE）发生之间相关性的报道。本研究旨在确定早期血运重建是否会影响日本稳定型CAD患者MCE的发生率。
我们回顾性调查了3581例接受静息铊和负荷锝-替曲膦心肌灌注单光子发射计算机断层扫描（SPECT）并提供三年预后数据的稳定型CAD患者。终点是由心源性死亡、非致命性心肌梗死和不稳定型心绞痛组成的MCE的发生。根据估计的倾向评分，将SPECT后60天内接受血运重建的患者与未接受血运重建的患者按1:1比例匹配（每组n = 450）。我们比较了两组之间与SPECT检测到的缺血心肌量相关的MCE发生率。
早期血运重建组和非早期血运重建组的MCE总发生率无显著差异（6.7%对8.7%，p = 0.2598）。然而，缺血≤5%的患者中，早期血运重建组的MCE发生率显著高于非早期血运重建组（5.8%对0.8%，p = 0.0226）。相反，缺血>10%的患者中，早期血运重建组的MCE发生率显著低于非早期血运重建组（7.0%对16.8%，p = 0.0036）。然而，缺血6 - 10%的患者中，早期血运重建组和非早期血运重建组的MCE发生率无显著差异（6.9%对4.1%，p = 0.3235）。
早期血运重建可能导致与治疗过程相关的MCE的发生，但对于中度至重度缺血患者，可能是一种改善预后的治疗策略。
