Rumana Umme, Kones Richard, Taheer Montather O, Elsayed Mohamed, Johnson Craig W
The University of Texas Health Science Center at Houston (UTHealth) School of Biomedical Informatics, Houston, TX 77030, USA.
Cardiology Section, Director, The Cardiometabolic Research Institute, Houston, TX 77054, USA.
J Cardiovasc Dev Dis. 2019 Nov 18;6(4):41. doi: 10.3390/jcdd6040041.
In diabetes patients with chronic ≥3 vessel disease, coronary artery bypass grafting (CABG) holds a class I recommendation in the American College of Cardiology and American Heart Association (ACC/AHA) 2011 guidelines, and this classification has not changed to date. Much of the literature has focused upon whether CABG or percutaneous coronary intervention (PCI) produces better outcomes; there is a paucity of data comparing the odds of receiving these procedures. A secondary analysis was conducted in a de-identified database comprised of 30,482 patients satisfying the entry criteria. Odds of occurrence (CABG, PCI) were determined as the binary dependent variable in period 1, (17 October 2009 through 31 December 2011), and period 2 (1 January 2013 through 16 March 2015), before and after the 2011 guidelines, while controlling for gender, ethnicity/race, and ischemic heart disease as covariates. The odds of performing CABG rather than PCI in period 2 were not statistically significantly different than in period 1 ( = 0.400). The logistic regression model chi-square statistic was statistically significant, with χ (7) = 308.850, < 0.0001. The Wald statistic showed that ethnicity/race (African American, Caucasian, Hispanic and Other), gender, and heart disease contributed significantly to the prediction model with < 0.05, but ethnicity 'Unknown' did not. The odds of CABG versus PCI in period 2 were 0.98 times those in period 1 95% confidence interval (CI) = (0.925, 1.032), statistically controlling for covariates. There was no significant rise in the odds of undergoing a CABG among this dataset of high-risk patients with diabetes and multivessel coronary heart disease. Modern practice has evolved regarding patient choice and additional variables that impact the final revascularization method employed. The degree to which odds of occurrence of procedures are a reliable surrogate for provider compliance with guidelines remains uncertain.
在患有慢性三支及以上血管病变的糖尿病患者中，冠状动脉旁路移植术（CABG）在美国心脏病学会和美国心脏协会（ACC/AHA）2011年指南中为I类推荐，且这一分类至今未变。许多文献聚焦于CABG与经皮冠状动脉介入治疗（PCI）哪种能产生更好的结果；比较接受这些手术几率的数据很少。在一个由30482名符合纳入标准的患者组成的匿名数据库中进行了一项二次分析。在2011年指南前后的第1阶段（2009年10月17日至2011年12月31日）和第2阶段（2013年1月1日至2015年3月16日），将发生几率（CABG、PCI）确定为二元因变量，同时将性别、种族/民族和缺血性心脏病作为协变量进行控制。第2阶段进行CABG而非PCI的几率与第1阶段相比无统计学显著差异（ = 0.400）。逻辑回归模型卡方统计量具有统计学显著性，χ（7） = 308.850， < 0.0001。Wald统计量显示，种族/民族（非裔美国人、白种人、西班牙裔和其他）、性别和心脏病对预测模型有显著贡献， < 0.05，但种族“未知”则不然。在对协变量进行统计学控制的情况下，第2阶段CABG与PCI的几率是第1阶段的0.98倍，95%置信区间（CI） = （0.925，1.032）。在这个患有糖尿病和多支冠状动脉疾病的高危患者数据集中，接受CABG的几率没有显著上升。关于患者选择以及影响最终血运重建方法的其他变量，现代实践已经有所发展。手术发生几率在多大程度上可作为医疗服务提供者遵循指南情况的可靠替代指标仍不确定。
