评估中国稳定性冠心病患者冠状动脉血运重建的适宜性与 1 年临床结局的相关性。
Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China.
机构信息
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
出版信息
Chin Med J (Engl). 2020 Jan 5;133(1):1-8. doi: 10.1097/CM9.0000000000000592.
BACKGROUND
The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization. This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients.
METHODS
We conducted a prospective, multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%. After the classification of appropriateness based on Chinese AUC, patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and ischemic symptoms with hospital admission.
RESULTS
From August 2016 to August 2017, 6085 patients were consecutively enrolled. Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.45-0.86; P = 0.004) than medical therapy in patients with appropriate indications (n = 1617). No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n = 2658, HR: 0.81; 95% CI: 0.52-1.25; P = 0.338) and inappropriate indications (n = 1810, HR: 0.80; 95% CI: 0.51-1.23; P = 0.308).
CONCLUSIONS
In patients with appropriate indications according to Chinese AUC, coronary revascularization was associated with significantly lower risk of MACCEs at 1 year. No benefit was found in coronary revascularization in patients with inappropriate indications. Our findings provide evidence for using Chinese AUC to guide clinical decision-making.
CLINICAL TRIAL REGISTRATION
NCT02880605. https://www.clinicaltrials.gov.
背景
中国冠状动脉血运重建适宜性标准（AUC）于 2016 年发布，旨在提高冠状动脉血运重建的应用。本研究旨在评估基于中国 AUC 的冠状动脉血运重建适宜性与稳定型冠状动脉疾病（CAD）患者 1 年结局之间的关系。
方法
我们进行了一项前瞻性、多中心的稳定型 CAD 患者队列研究，这些患者的冠状动脉病变狭窄程度≥50%。根据中国 AUC 进行适宜性分类后，根据治疗方法将患者分为冠状动脉血运重建组或药物治疗组。主要结局是死亡、心肌梗死、卒中和缺血症状伴住院的复合事件。
结果
2016 年 8 月至 2017 年 8 月，连续纳入 6085 例患者。在有适宜适应证的患者中（n=1617），与药物治疗相比，冠状动脉血运重建与 1 年主要不良心脑血管事件（MACCEs）的校正风险较低（危险比 [HR]：0.62；95%置信区间 [CI]：0.45-0.86；P=0.004）。在不确定适应证（n=2658）和不适宜适应证（n=1810）的患者中，与药物治疗相比，血运重建后 1 年的 MACCEs 无显著获益（HR：0.81；95% CI：0.52-1.25；P=0.338）和（HR：0.80；95% CI：0.51-1.23；P=0.308）。
结论
根据中国 AUC，对于有适宜适应证的患者，冠状动脉血运重建与 1 年 MACCEs 风险显著降低相关。对于不适宜适应证的患者，冠状动脉血运重建无获益。我们的研究结果为使用中国 AUC 指导临床决策提供了证据。
临床试验注册
NCT02880605。https://www.clinicaltrials.gov。
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