Tang Bing, Yang Hua
Department of Cardiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, PR China.
Medicine (Baltimore). 2019 Aug;98(33):e16905. doi: 10.1097/MD.0000000000016905.
The prognosis of patients with coronary artery disease is mainly related to the extent of myocardium at risk. Proximal coronary arteries, especially the proximal left anterior descending coronary artery (LAD), supply a large part of the myocardium. In this analysis, we aimed to systematically compare the post percutaneous coronary interventional (PCI) outcomes observed with proximal vs non-proximal lesions of the left and right coronary arteries.
MEDLARS Online, Excerpta Medica database, www.ClinicalTrials.gov, and the Cochrane databases were searched for relevant studies comparing the post PCI outcomes reported on proximal vs non-proximal lesions of the coronary arteries. RevMan software version 5.3 was used to analyze the data to generate respective results. Odds ratios (OR) and 95% confidence intervals (CI) were derived to represent the results appropriately.
Six studies with a total number of 11,109 participants who were enrolled between 1990 and 2015 were included in this analysis. The current results showed major adverse cardiac events (MACEs) (OR: 1.28, 95% CI: 1.14-1.45; P = .0001) and mortality (OR: 1.70, 95% CI: 1.43-2.03; P = .00001) to be significantly higher with proximal compared to non-proximal coronary lesions irrespective of the follow-up time periods. However, re-infarction (OR: 1.05, 95% CI: 0.80-1.38; P = .71), repeated revascularization (OR: 1.08, 95% CI: 0.92-1.27; P = .35) and stent thrombosis (OR: 0.59, 95% CI: 0.27-1.31; P = .20) were not significantly different.When patients specifically with LAD lesions were compared with associated non-proximal lesions, mortality was still significantly higher with proximal lesions (OR: 2.26, 95% CI: 1.52-3.36; P = .0001). However, when patients with right proximal coronary artery lesions were compared with the corresponding non-proximal lesions, no significant difference was observed in mortality.
In-hospital and long-term MACEs and mortality were significantly higher in patients with proximal compared to non-proximal coronary lesions following PCI. In addition, mortality was significantly higher in patients with proximal LAD lesions whereas no significant difference was observed in patients with right proximal coronary artery lesions. Larger trials should further confirm these hypotheses.
冠心病患者的预后主要与心肌梗死风险范围有关。冠状动脉近端，尤其是左冠状动脉前降支近端（LAD），供应大部分心肌。在本分析中，我们旨在系统比较经皮冠状动脉介入治疗（PCI）后，左、右冠状动脉近端与非近端病变的观察结果。
检索医学文献分析和检索系统在线数据库（MEDLARS Online）、医学文摘数据库、美国国立医学图书馆临床试验注册网站（www.ClinicalTrials.gov）和考克兰数据库，查找比较冠状动脉近端与非近端病变PCI后结果的相关研究。使用RevMan 5.3软件分析数据以得出各自的结果。计算比值比（OR）和95%置信区间（CI）以恰当地表示结果。
本分析纳入了6项研究，共有11109名参与者，入组时间为1990年至2015年。当前结果显示，无论随访时间段如何，与非近端冠状动脉病变相比，近端病变的主要不良心脏事件（MACE）（OR：1.28，95%CI：1.14 - 1.45；P = 0.0001）和死亡率（OR：1.70，95%CI：1.43 - 2.03；P = 0.00001）显著更高。然而，再梗死（OR：1.05，95%CI：0.80 - 1.38；P = 0.71）、重复血运重建（OR：1.08，95%CI：0.92 - 1.27；P = 0.35）和支架血栓形成（OR：0.59，95%CI：0.27 - 1.31；P = 0.20）无显著差异。当将单纯LAD病变患者与相关非近端病变患者进行比较时，近端病变患者的死亡率仍显著更高（OR：2.26，95%CI：1.52 - 3.36；P = 0.0001）。然而，当将右冠状动脉近端病变患者与相应的非近端病变患者进行比较时，未观察到死亡率有显著差异。
PCI后，冠状动脉近端病变患者的院内及长期MACE和死亡率显著高于非近端病变患者。此外，LAD近端病变患者的死亡率显著更高，而右冠状动脉近端病变患者未观察到显著差异。更大规模的试验应进一步证实这些假设。
