Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Cardiol. 2019 May;73(5):432-437. doi: 10.1016/j.jjcc.2018.12.008. Epub 2019 Jan 2.
Limited data are available regarding the long-term clinical outcomes of percutaneous coronary intervention (PCI) using second-generation drug-eluting stents (DESs) versus coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD) with chronic total occlusion (CTO). We compared the clinical outcomes of patients with multivessel CAD including CTO lesions treated with PCI using DESs versus CABG.
We analyzed data from 423 consecutive patients who underwent successful revascularization for CTO between March 2008 and February 2012. Death or myocardial infarction (MI) and major adverse cardiac and cerebrovascular events (MACCE) were compared between patients treated with PCI using second-generation DESs (n=232, 2nd DES group) versus those treated with CABG (n=191, CABG group). To reduce selection bias according to treatment strategy and other potential confounding factors, inverse probability of treatment weighting (IPTW) was also performed.
During a median follow-up duration of 32 months, there was no significant difference in death or MI [hazard ratio (HR): 0.69; 95% confidence interval (CI): 0.29-1.63; p=0.399] or MACCE (HR: 1.32; 95% CI: 0.74-2.35; p=0.341) between the 2nd DES group and the CABG group based on multivariable analysis. After IPTW adjustment, the incidences of death or MI (HR: 0.72; 95% CI: 0.26-1.95; p=0.518) and MACCE (HR: 1.49; 95% CI: 0.76-2.91; p=0.244) remained similar in the two groups. In subgroup analysis, the effect of second-generation drug-eluting stenting was comparable to that of CABG across various subgroups without a significant p-value for the interaction.
The efficacy of PCI using second-generation DES was comparable to that of CABG in CTO patients with multivessel CAD.
关于使用第二代药物洗脱支架（DES）行经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗伴有慢性完全闭塞（CTO）的冠状动脉疾病（CAD）的长期临床结局，目前仅有有限的数据。我们比较了多支血管 CAD 合并 CTO 病变患者接受第二代 DES 支架 PCI 与 CABG 的临床结局。
我们分析了 2008 年 3 月至 2012 年 2 月期间成功接受 CTO 血运重建的 423 例连续患者的数据。比较了接受第二代 DES 支架 PCI（2nd DES 组，n=232）治疗与 CABG（CABG 组，n=191）治疗的患者之间的死亡率或心肌梗死（MI）和主要不良心脏和脑血管事件（MACCE）。为了根据治疗策略和其他潜在混杂因素减少选择偏倚，还进行了逆概率治疗加权（IPTW）。
在中位随访 32 个月期间，多变量分析显示，2 组之间死亡率或 MI（风险比 [HR]：0.69；95%置信区间 [CI]：0.29-1.63；p=0.399）或 MACCE（HR：1.32；95% CI：0.74-2.35；p=0.341）无显著差异。在 IPTW 调整后，2 组之间的死亡率或 MI（HR：0.72；95% CI：0.26-1.95；p=0.518）和 MACCE（HR：1.49；95% CI：0.76-2.91；p=0.244）发生率仍然相似。在亚组分析中，第二代药物洗脱支架的效果在没有交互作用的显著 p 值的情况下，在各种亚组中与 CABG 相当。
在多支血管 CAD 合并 CTO 的患者中，第二代 DES 支架 PCI 的疗效与 CABG 相当。
