New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn (S.J.B.).
University of Padua Medical School, Italy (G.T.).
Circ Cardiovasc Interv. 2018 Jul;11(7):e006488. doi: 10.1161/CIRCINTERVENTIONS.118.006488.
Despite advances in technology and technique, a substantial proportion of patients still die within several years after percutaneous coronary intervention (PCI). The relative rates of cardiovascular and noncardiovascular death after PCI remain uncertain.
We pooled individual patient-level data from 21 randomized clinical trials of PCI performed in 32 882 patients. All studies had independent adjudication of clinical events. We calculated the relative ratio of cardiovascular to noncardiovascular death in each trial up to 5 years and identified predictors of all-cause, cardiovascular, and noncardiovascular death. At the end of the follow-up period, 1980 patients had died (Kaplan-Meier estimated mortality rate, 9.19%). The rates of cardiovascular and noncardiovascular mortality at 5 years were 4.23% (945) and 5.17% (1035), respectively. The rate of cardiovascular death was higher than noncardiovascular death in the first 30 days after PCI (relative ratio, 6.99; 95% confidence interval, 3.16-15.42; <0.001), similar between 30 days and 1 year, and lower between 1 and 5 years (relative ratio, 0.70; 95% confidence interval, 0.58-0.84; =0.0005). Any adverse cardiac event (definite stent thrombosis, spontaneous myocardial infarction, or repeat revascularization) preceded cardiovascular and noncardiovascular mortality in 292 (30.9%) and 151 (14.6%) patients, respectively. In a multivariable model with adverse events entered as time-adjusted covariates, myocardial infarction and definite ST were associated with early and late all-cause and cardiovascular mortality but not noncardiovascular mortality.
In this large-scale study of patients undergoing PCI, the 5-year rates of cardiovascular and noncardiovascular mortality were similar, but their relative timing was different.
尽管技术和技术有所进步，但仍有相当一部分患者在经皮冠状动脉介入治疗（PCI）后数年内死亡。PCI 后心血管和非心血管死亡的相对比率仍不确定。
我们从 32882 例接受 PCI 的随机临床试验的 21 项个体患者水平数据中进行了汇总。所有研究均对临床事件进行了独立裁决。我们计算了每个试验中直至 5 年的心血管与非心血管死亡的相对比值，并确定了全因、心血管和非心血管死亡的预测因素。在随访期末，有 1980 例患者死亡（Kaplan-Meier 估计死亡率为 9.19%）。5 年时心血管和非心血管死亡率分别为 4.23%（945）和 5.17%（1035）。PCI 后 30 天内心血管死亡率高于非心血管死亡率（相对比值 6.99；95%置信区间 3.16-15.42；<0.001），30 天至 1 年之间相似，1 至 5 年之间较低（相对比值 0.70；95%置信区间 0.58-0.84；=0.0005）。任何不良心脏事件（确定的支架血栓形成、自发性心肌梗死或再次血运重建）分别在 292 例（30.9%）和 151 例（14.6%）患者中先于心血管和非心血管死亡率发生。在一个将不良事件作为时间调整协变量输入的多变量模型中，心肌梗死和明确 ST 与全因和心血管死亡的早期和晚期相关，但与非心血管死亡无关。
在这项对接受 PCI 的患者进行的大规模研究中，心血管和非心血管死亡的 5 年发生率相似，但相对时间不同。
