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, Skłodowskiej-Curie 9, 41-800 Zabrze, Poland.
Kardiol Pol. 2018;76(10):1474-1481. doi: 10.5603/KP.a2018.0151. Epub 2018 Sep 25.
There are no clinical trials comparing multivessel percutaneous coronary intervention (MV PCI) with coronary artery bypass grafting (CABG) in the non-ST-segment elevation acute coronary syndrome (NSTE-ACS) population.
We sought to compare long-term outcomes of MV PCI and CABG in patients with severe coronary artery disease (CAD) presenting with NSTE-ACS.
A total of 3166 consecutive patients with NSTE-ACS hospitalised between 2006 and 2014 were analysed. Patients with left main, proximal left anterior descending artery, or triple-vessel CAD were included in further analysis. Finally, 455 patients were enrolled and divided into two groups (MV PCI or CABG group). The Cox proportional hazards model and propensity score analysis were used to assess the effects of the treatment on 36-month outcomes.
MV PCI was performed in 335 patients, the remaining 120 patients underwent CABG. After propensity score analysis, 99 well-matched pairs were chosen. At 36 months MV PCI was associated with similar incidence of the composite endpoint (all-cause death, non-fatal myocardial infarction [MI], ACS-driven, revascularisation, or stroke) in both Cox proportional hazards model (hazard ratio [HR] 1.26; 95% confidence interval [CI] 0.75-2.11; p = 0.39) and propensity matched analysis (HR 1.28; 95% CI 0.75-2.21; p = 0.36). Rates of 36-month mortality were also comparable before (HR 0.90; 95% CI 0.46-1.75; p = 0.76) and after matching (HR 0.94; 95% CI 0.47-1.89; p = 0.87). Rates of MI and ACS-driven revascularisation were independently higher in MV PCI than in CABG groups (17.8% vs. 5.5%, p = 0.01, and 20.6% vs. 4.4%, p = 0.003, respectively).
It seems that MV PCI is comparable to CABG in terms of long-term combined endpoint and mortality in patients with severe CAD and NSTE-ACS. However, higher rates of MI and ACS-driven revascularisation were observed in the MV PCI group.
在非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）人群中，尚无比较多支经皮冠状动脉介入治疗（MV PCI）与冠状动脉旁路移植术（CABG）的临床试验。
我们旨在比较严重冠状动脉疾病（CAD）合并 NSTE-ACS 患者行 MV PCI 与 CABG 的长期预后。
共分析了 2006 年至 2014 年期间住院的 3166 例连续 NSTE-ACS 患者。左主干、近端左前降支或三血管 CAD 患者纳入进一步分析。最终，纳入 455 例患者并分为两组（MV PCI 或 CABG 组）。采用 Cox 比例风险模型和倾向评分分析评估治疗对 36 个月结局的影响。
335 例行 MV PCI，120 例行 CABG。行倾向评分分析后，选择了 99 对匹配良好的患者。36 个月时，Cox 比例风险模型（风险比 [HR] 1.26；95%置信区间 [CI] 0.75-2.11；p = 0.39）和倾向评分匹配分析（HR 1.28；95% CI 0.75-2.21；p = 0.36）均显示 MV PCI 与复合终点（全因死亡、非致死性心肌梗死 [MI]、ACS 驱动的血运重建、血运重建或卒中）发生率无差异。36 个月死亡率也相似，匹配前（HR 0.90；95% CI 0.46-1.75；p = 0.76）和匹配后（HR 0.94；95% CI 0.47-1.89；p = 0.87）。与 CABG 组相比，MV PCI 组的 MI 和 ACS 驱动的血运重建发生率更高（17.8% vs. 5.5%，p = 0.01；20.6% vs. 4.4%，p = 0.003）。
在严重 CAD 和 NSTE-ACS 患者中，MV PCI 与 CABG 相比，在长期复合终点和死亡率方面似乎相当。然而，MV PCI 组的 MI 和 ACS 驱动的血运重建发生率更高。
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