Division of Cardiology, 2C2 Walter Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta T6G 2B7, Canada.
Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada.
Eur Heart J Qual Care Clin Outcomes. 2017 Jul 1;3(3):216-223. doi: 10.1093/ehjqcco/qcw055.
The aim of this study is to investigate the long-term relationship between revascularization technique and health status in diabetics with multivessel disease.
Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) registry, we captured 1319 diabetics with multivessel disease requiring revascularization for an acute coronary syndrome (January 2009-December 2012) and reported health status using the Seattle Angina Questionnaire (SAQ) at baseline, 1, 3 and 5-years [599 underwent coronary artery bypass grafting (CABG); 720 underwent percutaneous coronary intervention (PCI)]. Adjusted analyses were performed using a propensity score-matching technique. After adjustment (including baseline SAQ domain scores), 1-year mean (95% CI) SAQ scores (range 0-100 with higher scores reflecting improved health status) were significantly greater in selected domains for CABG compared to PCI (exertional capacity: 81.7 [79.5-84.0] vs. 78.8 [76.5-81.0], P = 0.07; angina stability: 83.1 [80.4-85.9] vs. 75.0 [72.3-77.8], P < 0.001]; angina frequency 93.2 [91.6-95.0] vs. 90.0 [87.8-91.3], P = 0.003; treatment satisfaction: 93.6 [92.2-94.9] vs. 90.8 [89.2-92.0], P = 0.003; quality of life [QOL]: 83.8 [81.7-85.8] vs. 77.2 [75.2-79.2] P < 0.001). At 3-years, these benefits were attenuated (exertional capacity: 79.3 [76.9-81.7] vs. 78.7 [76.3-81.1], P = 0.734; angina stability 79.3 [76.3-82.3] vs. 75.5 [72.5-78.5], P = 0.080; angina frequency: 93.2 [91.3-95.1] vs. 90.9 [89.0-92.8], P = 0.095; treatment satisfaction: 92.5 [91.0-94.0] vs. 91.5 [90.0-93.0] P = 0.382; QOL: 83.2 [81.1-85.2] vs. 80.3 [78.2-82.4], P = 0.057). At 5-years, majority of domains were similar (exertional capacity: 77.8 [75.0-80.6] vs. 76.3 [73.2-79.3], P = 0.482; angina stability: 78.0 [74.8-81.2] vs. 74.8 [71.4-78.2], P = 0.175; angina frequency: 94.2 [92.3-96.0] vs. 90.9 [89.0-92.9], P = 0.018; treatment satisfaction: 93.7 [92.2-95.1] vs. 92.2 [90.6-93.7], P = 0.167; QOL: 84.1 [82.0-86.3] vs. 81.1 [78.8-83.4], P = 0.058). Majority in both groups remained angina-free at 5-years (75.0% vs. 70.3%, P = 0.15).
Improvements in health status with CABG compared with PCI were not sustained long-term. This temporal sequence should be considered when contemplating a revascularization strategy in diabetics with multivessel disease.
本研究旨在探讨多血管病变糖尿病患者血运重建技术与健康状况之间的长期关系。
利用阿尔伯塔省冠心病项目结局评估（APPROACH）登记处，我们纳入了 1319 例因急性冠状动脉综合征而需要血运重建的多血管病变糖尿病患者（2009 年 1 月至 2012 年 12 月），并使用西雅图心绞痛问卷（SAQ）在基线、1 年、3 年和 5 年时报告健康状况[599 例行冠状动脉旁路移植术（CABG）；720 例行经皮冠状动脉介入治疗（PCI）]。使用倾向评分匹配技术进行了校正分析。校正后（包括基线 SAQ 各领域评分），CABG 组的 SAQ 各领域评分（范围 0-100，分数越高表示健康状况改善越大）在 1 年时显著高于 PCI 组（体力活动能力：81.7 [79.5-84.0] vs. 78.8 [76.5-81.0]，P=0.07；稳定性心绞痛：83.1 [80.4-85.9] vs. 75.0 [72.3-77.8]，P<0.001）；心绞痛发作频率 93.2 [91.6-95.0] vs. 90.0 [87.8-91.3]，P=0.003；治疗满意度 93.6 [92.2-94.9] vs. 90.8 [89.2-92.0]，P=0.003；生活质量（QOL）[83.8 [81.7-85.8] vs. 77.2 [75.2-79.2]，P<0.001]。3 年时，这些获益减弱（体力活动能力：79.3 [76.9-81.7] vs. 78.7 [76.3-81.1]，P=0.734；稳定性心绞痛 79.3 [76.3-82.3] vs. 75.5 [72.5-78.5]，P=0.080；心绞痛发作频率：93.2 [91.3-95.1] vs. 90.9 [89.0-92.8]，P=0.095；治疗满意度：92.5 [91.0-94.0] vs. 91.5 [90.0-93.0]，P=0.382；QOL：83.2 [81.1-85.2] vs. 80.3 [78.2-82.4]，P=0.057）。5 年时，大多数领域相似（体力活动能力：77.8 [75.0-80.6] vs. 76.3 [73.2-79.3]，P=0.482；稳定性心绞痛：78.0 [74.8-81.2] vs. 74.8 [71.4-78.2]，P=0.175；心绞痛发作频率：94.2 [92.3-96.0] vs. 90.9 [89.0-92.9]，P=0.018；治疗满意度：93.7 [92.2-95.1] vs. 92.2 [90.6-93.7]，P=0.167；QOL：84.1 [82.0-86.3] vs. 81.1 [78.8-83.4]，P=0.058）。两组在 5 年内均有多数患者无心绞痛发作（75.0% vs. 70.3%，P=0.15）。
与 PCI 相比，CABG 改善健康状况的效果不能长期维持。在考虑多血管病变糖尿病患者的血运重建策略时，应考虑到这种时间顺序。
