University at Albany, State University of New York, Rensselaer.
Retired.
JAMA Cardiol. 2018 Feb 1;3(2):123-130. doi: 10.1001/jamacardio.2017.4787.
Many studies have compared outcomes for incomplete revascularization (IR) among patients undergoing percutaneous coronary interventions (PCI), but little is known about whether outcomes are related to the nature of the IR.
To determine whether some coronary vessel characteristics are associated with worse outcomes in patients with PCI with IR.
DESIGN, SETTING, AND PARTICIPANTS: New York's PCI registry was used to examine mortality (median follow-up, 3.4 years) as a function of the number of vessels that were incompletely revascularized, the stenosis in those vessels, and whether the proximal left anterior descending artery was incompletely revascularized after controlling for other factors associated with mortality for patients with and without ST-elevation myocardial infarction (STEMI). This was a multicenter study (all nonfederal PCI hospitals in New York State) that included 41 639 New York residents with multivessel coronary artery disease undergoing PCI in New York State between January 1, 2010, and December 31, 2012.
Percutaneous coronary interventions, with complete and incomplete revascularization.
Medium-term mortality.
For patients with STEMI, the mean age was 62.8 years; 26.2% were women, 11.9% were Hispanic, and 81.5% were white. For other patients, the mean age was 66.6 years, 29.1% were women, 11.3% were Hispanic, and 79.1% were white. Incomplete revascularization was very common (78% among patients with STEMI and 71% among other patients). Patients with IR in a vessel with at least 90% stenosis were at higher risk than other patients with IR. This was not significant among patients with STEMI (17.18% vs 12.86%; adjusted hazard ratio [AHR], 1.16; 95% CI, 0.99-1.37) and significant among patients without STEMI (17.71% vs 12.96%; AHR, 1.15; 95% CI, 1.07-1.24). Similarly, patients with IR in 2 or more vessels had higher mortality than patients with completely revascularization and higher mortality than other patients with IR among patients with STEMI (20.37% vs 14.39%; AHR, 1.35; 95% CI, 1.15-1.59) and among patients without STEMI (20.10% vs 12.86%; AHR, 1.17; 95% CI, 1.09-1.59). Patients with proximal left anterior descending artery vessel IR had higher mortality than other patients with IR (20.09% vs 14.67%; AHR, 1.31; 95% CI, 1.04-1.64 for patients with STEMI and 20.78% vs 15.62%; AHR, 1.11; 95% CI, 1.01-1.23 for patients without STEMI). More than 20% of all PCI patients had IR of 2 or more vessels and more than 30% had IR with more than 90% stenosis.
Patients with IR are at higher risk of mortality if they have IR with at least 90% stenosis, IR in 2 or more vessels, or proximal left anterior descending IR.
许多研究比较了经皮冠状动脉介入治疗（PCI）中不完全血运重建（IR）患者的结局，但对于结局是否与 IR 的性质有关知之甚少。
确定在 IR 患者中，某些冠状动脉血管特征是否与更差的结局相关。
设计、地点和参与者：使用纽约的 PCI 登记处，检查死亡率（中位随访时间 3.4 年）与不完全血运重建的血管数量、这些血管中的狭窄程度以及左前降支近端是否不完全血运重建之间的关系，控制了与 STEMI 患者和非 STEMI 患者死亡率相关的其他因素。这是一项多中心研究（纽约州所有非联邦 PCI 医院），包括 41639 名纽约州多支冠状动脉疾病患者，他们在 2010 年 1 月 1 日至 2012 年 12 月 31 日期间在纽约州接受 PCI。
PCI，完全和不完全血运重建。
中期死亡率。
对于 STEMI 患者，平均年龄为 62.8 岁；26.2%为女性，11.9%为西班牙裔，81.5%为白人。对于其他患者，平均年龄为 66.6 岁，29.1%为女性，11.3%为西班牙裔，79.1%为白人。IR 非常常见（STEMI 患者中为 78%，其他患者中为 71%）。至少 90%狭窄的血管存在 IR 的患者比其他存在 IR 的患者风险更高。这在 STEMI 患者中不显著（17.18%比 12.86%；调整后的危险比[AHR]，1.16；95%CI，0.99-1.37），但在非 STEMI 患者中显著（17.71%比 12.96%；AHR，1.15；95%CI，1.07-1.24）。同样，在 2 个或更多血管存在 IR 的患者死亡率高于完全血运重建的患者，在 STEMI 患者中高于其他存在 IR 的患者（20.37%比 14.39%；AHR，1.35；95%CI，1.15-1.59），在非 STEMI 患者中高于其他存在 IR 的患者（20.10%比 12.86%；AHR，1.17；95%CI，1.09-1.59）。左前降支近端血管 IR 的患者死亡率高于其他存在 IR 的患者（20.09%比 14.67%；AHR，1.31；95%CI，1.04-1.64，对于 STEMI 患者；20.78%比 15.62%；AHR，1.11；95%CI，1.01-1.23，对于非 STEMI 患者）。超过 20%的所有 PCI 患者存在 2 个或更多血管的 IR，超过 30%的患者存在超过 90%狭窄的 IR。
如果患者存在至少 90%狭窄、2 个或更多血管存在 IR 或左前降支近端 IR，那么他们的死亡率风险更高。
