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经药物洗脱支架血管成形术治疗的多支冠状动脉疾病患者的急性和长期结局的比较:完全与不完全血运重建。

Comparison of the Acute and Long-Term Outcomes of Patients With Multivessel Coronary Artery Disease After Angiographic Complete and Incomplete Revascularization With Drug-Eluting Stents.

机构信息

Division of Cardiology, Department of Medicine and Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine.

出版信息

Circ J. 2018 Mar 23;82(4):992-998. doi: 10.1253/circj.CJ-17-0812. Epub 2018 Mar 2.

Abstract

BACKGROUND

Data regarding the long-term outcomes of a large patient population with multivessel coronary artery disease (MV-CAD) after complete revascularization (CR) and incomplete revascularization (IR) with drug-eluting stent (DES) implantation are controversial. The objective of this study was to evaluate differences between the clinical outcomes of CR and IR in such patients.

METHODS AND RESULTS

A total of 1,502 patients with MV-CAD who received DES between April 2005 and August 2016 were enrolled in this study after propensity score matching. The CR group had 751 patients with 1,368 stents implanted in 1,215 lesions, and the IR group had 751 patients with 1,077 stents implanted in 948 lesions. The CR group had a similar rate of in-hospital major adverse cardiovascular events to the IR group (1.9% vs. 1.6%, P=0.844). Follow-up angiography at 9 months showed no significant difference between the 2 groups for restenosis. The CR group had a higher cardiovascular event-free survival rate than the IR group during a mean follow-up period of 71±62 months (81.8% vs. 72.0%, P<0.001). Kaplan-Meier survival analysis also showed better results in the CR group than in the IR group.

CONCLUSIONS

Angiographic CR was associated with more favorable long-term cardiovascular outcomes than angiographic IR in patients with MV-CAD after DES implantation.

摘要

背景

关于多支冠状动脉疾病(MV-CAD)患者在接受药物洗脱支架(DES)植入后完全血运重建(CR)和不完全血运重建(IR)的长期结局数据存在争议。本研究旨在评估此类患者中 CR 和 IR 临床结局的差异。

方法和结果

共纳入 1502 例 2005 年 4 月至 2016 年 8 月期间接受 DES 治疗的 MV-CAD 患者,经倾向评分匹配后分为 CR 组(n=751,植入 1368 枚支架于 1215 处病变)和 IR 组(n=751,植入 1077 枚支架于 948 处病变)。CR 组住院期间主要不良心血管事件发生率与 IR 组相似(1.9% vs. 1.6%,P=0.844)。9 个月时的随访造影显示两组间再狭窄无显著差异。在平均 71±62 个月的随访期间,CR 组的心血管事件无复发生存率高于 IR 组(81.8% vs. 72.0%,P<0.001)。Kaplan-Meier 生存分析也显示 CR 组的结果优于 IR 组。

结论

与 DES 植入后 MV-CAD 患者的血管造影 IR 相比,血管造影 CR 与更有利的长期心血管结局相关。

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