Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Catheter Cardiovasc Interv. 2019 Sep 1;94(3):E104-E110. doi: 10.1002/ccd.28107. Epub 2019 Jan 28.
To determine procedural predictors of long-term outcomes for patients with radiation associated coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI).
Patients who develop CAD after external beam radiation therapy (XRT) for cancer are at high-risk for adverse events following PCI. It is unknown if specific angiographic features can predict outcomes in this population.
This is an observational study of 157 patients with malignancy who received XRT prior to PCI. Rates of major adverse cardiovascular and cerebrovascular events (MACCEs; all-cause mortality, myocardial infarction, repeat revascularization, or stroke) were compared across patient characteristics over time with the Cox proportional hazards and Kaplan-Meier's analyses.
During follow-up of 5.4 ± 4.5 years, 91 (58%) patients had MACCE. On Kaplan-Meier's analysis of angiographic characteristics, MACCE was more frequent in patients with at least moderate target vessel calcification (P = 0.023), ostial stenosis (P = 0.049), target vessel diameter ≥ 3.0 mm (P = 0.018), a SYNTAX score ≥ the median of 11 (P = 0.014), or bare metal stenting (BMS)/balloon angioplasty (BA) compared to drug-eluting stenting (DES) (P = 0.006). Cardiac death was more frequent in patients with SYNTAX score ≥ 11 (P = 0.028) or BMS (P = 0.043). After multivariable adjustment for both angiographic and clinical characteristics, independent predictors of MACCE were BMS placement (P = 0.013), chronic kidney disease ≥ stage 3 (P = 0.019), New York Heart Association (NYHA) heart failure class ≥3 (P = 0.034), and SYNTAX score ≥ 11 (P = 0.041).
In patients previously exposed to XRT treated with PCI, independent angiographic predictors of MACCE include SYNTAX score ≥ 11 and BMS placement, suggestive that DES should be preferred in this population.
确定因辐射相关冠状动脉疾病（CAD）接受经皮冠状动脉介入治疗（PCI）的患者的长期预后的程序预测因素。
因癌症接受外照射放射治疗（XRT）后发生 CAD 的患者在 PCI 后发生不良事件的风险较高。尚不清楚特定的血管造影特征是否可以预测该人群的结果。
这是一项对 157 名接受 XRT 治疗后接受 PCI 的恶性肿瘤患者的观察性研究。使用 Cox 比例风险和 Kaplan-Meier 分析比较患者特征随时间的变化与主要不良心血管和脑血管事件（MACCE；全因死亡率、心肌梗死、再次血运重建或中风）的发生率。
在 5.4±4.5 年的随访期间，91 名（58%）患者发生 MACCE。在血管造影特征的 Kaplan-Meier 分析中，在至少有中度靶血管钙化（P=0.023）、开口狭窄（P=0.049）、靶血管直径≥3.0mm（P=0.018）、SYNTAX 评分≥中位数 11（P=0.014）或使用裸金属支架（BMS）/球囊血管成形术（BA）的患者中，MACCE 更为常见，而不是药物洗脱支架（DES）（P=0.006）。在 SYNTAX 评分≥11（P=0.028）或 BMS（P=0.043）的患者中，心脏死亡更为常见。在对血管造影和临床特征进行多变量调整后，MACCE 的独立预测因素为 BMS 放置（P=0.013）、慢性肾脏病≥3 期（P=0.019）、纽约心脏协会（NYHA）心力衰竭分级≥3 级（P=0.034）和 SYNTAX 评分≥11（P=0.041）。
在先前接受 XRT 治疗后接受 PCI 的患者中，MACCE 的独立血管造影预测因素包括 SYNTAX 评分≥11 和 BMS 放置，这表明在该人群中应首选 DES。
