Desperak Piotr, Hawranek Michał, Gąsior Paweł, Desperak Aneta, Lekston Andrzej, Gąsior Mariusz
3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland.
Division of Cardiology and Structural Heart Diseases, Medical University of Silesia in Katowice, Katowice, Poland.
Cardiol J. 2019;26(2):157-168. doi: 10.5603/CJ.a2017.0110. Epub 2017 Oct 5.
There is paucity of data concerning the optimal revascularization in patients with mul- tivessel coronary artery disease (CAD) presenting non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The aim was to evaluate long-term outcomes of patients with multivessel CAD presenting NSTE-ACS depending on the management after coronary angiography.
3,166 patients with NSTE-ACS hospitalized between 2006 and 2014 were screened. After ex- clusions, 1,342 patients were enrolled with multivessel CAD and were divided depending on their man- agement after coronary angiography; the medical-only therapy group (n = 91), the percutaneous coronary intervention (PCI) group (n = 1,122), the coronary artery bypass grafting (CABG) group (n = 129). Propensity scores matching was used to adjust for differences in patient baseline characteristics.
After propensity score analysis, 273 well-matched patients were chosen. Both before and after matching, patients treated with a medical-only therapy were burdened with the highest percentage of 24-month all-cause death and non-fatal MI in comparison to PCI and CABG groups, respectively. In the CABG group, ACS-driven revascularization rate was lowest. In the overall population, PCI (HR 0.33; 95% CI 0.20-0.53; p < 0.0001) and CABG (HR 0.54; 95% CI 0.31-0.93; p = 0.028) were independent factors associated with favorable 24-month prognosis. However, in a matched population only PCI was an independent predictor of long-term prognosis with a 63% decrease of 24-month mortal- ity (HR 0.37; 95% CI 0.19-0.69; p = 0.0020).
In patients with multivessel CAD presenting with NSTE-ACS, medical-only man- agement is related with adverse long-term prognosis in contrast to revascularization, which reduces 24-month mortality, especially among patients undergoing percutaneous intervention. Performance of PCI is an independent factor for improving long-term prognosis.
关于多支冠状动脉疾病（CAD）合并非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者的最佳血运重建治疗，相关数据较少。本研究旨在根据冠状动脉造影后的治疗方式，评估多支CAD合并NSTE-ACS患者的长期预后。
对2006年至2014年期间住院的3166例NSTE-ACS患者进行筛查。排除后，1342例多支CAD患者入组，并根据冠状动脉造影后的治疗方式分为单纯药物治疗组（n = 91）、经皮冠状动脉介入治疗（PCI）组（n = 1122）、冠状动脉旁路移植术（CABG）组（n = 129）。采用倾向评分匹配法调整患者基线特征的差异。
经过倾向评分分析，选择了273例匹配良好的患者。在匹配前后，与PCI组和CABG组相比，单纯药物治疗的患者24个月全因死亡和非致死性心肌梗死的发生率最高。在CABG组中，ACS驱动的血运重建率最低。在总体人群中，PCI（HR 0.33；95%CI 0.20 - 0.53；p < 0.0001）和CABG（HR 0.54；95%CI 0.31 - 0.93；p = 0.028）是与24个月良好预后相关的独立因素。然而，在匹配人群中，只有PCI是长期预后的独立预测因素，24个月死亡率降低63%（HR 0.37；95%CI 0.19 - 0.69；p = 0.0020）。
对于多支CAD合并NSTE-ACS的患者，与血运重建治疗相比，单纯药物治疗与不良的长期预后相关，血运重建治疗可降低24个月死亡率，尤其是在接受经皮介入治疗的患者中。PCI治疗是改善长期预后的独立因素。
