高龄患者非保护左主干和分叉病变的经皮冠状动脉介入治疗：RAIN 研究（真实世界中左主干或分叉病变患者应用极细支架的亚组分析）。

Percutaneous coronary intervention of unprotected left main and bifurcation in octogenarians: Subanalysis from RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life).

机构信息

Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Torino, Italy.

U.O.C. Cardiologia, Ospedale San Giovanni Evangelista, Rome, Italy.

出版信息

Catheter Cardiovasc Interv. 2021 Apr 1;97(5):755-763. doi: 10.1002/ccd.29048. Epub 2020 Jun 1.

DOI:10.1002/ccd.29048

PMID:32478451

Abstract

OBJECTIVE

Outcomes of complex percutaneous coronary interventions (PCIs) in older patients are still debated. The aim of the study was to evaluate clinical outcomes of Octogenarian patients treated with ultrathinstents on left main or on coronary bifurcations, compared with younger patients.

METHODS

All consecutive patients presenting a critical lesion of an unprotected left main (ULM) or a bifurcation and treated with very thin stents were included in the RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) registry and divided into octogenarians group (OG, 551 patients) and nonoctogenarians (NOGs, 2,453 patients). Major adverse cardiovascular event (MACE), a composite end point of all-cause death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST), was the primary endpoint, while MACE components, cardiovascular (CV) death, and target vessel revascularization (TVR) were the secondary ones.

RESULTS

Indication for PCI was acute coronary syndrome in 64.7% of the OG versus 53.1% of the NOG. Severe calcifications and a diffuse disease were significantly more in OG. After a follow-up of 15.2 ± 10.3 months, MACEs were higher in the OG than in the NOG patients (OG 19.1% vs. NOG 11.2%, p < .001), along with MI (OG 6% vs. NOG 3.4%, p = .002) and all-cause death (OG 14% vs. NOG 4.3%, p < .001). In contrast, no significant difference was detected in CV-death (OG 5.1% vs. NOG 4%, p = .871), TVR/TLR, or ST. At multivariate analysis, age was not an independent predictor of MACE (OR 1.02 CI 95% 0.76-1.38), while it was for all-cause death, along with diabetes, GFR < 60 ml/min, and ULM disease.

DISCUSSION

Midterm outcomes of complex PCI in OG are similar to those of younger patients. However, due to the higher non-CV death rate, accurate patient selection is mandatory.

摘要

目的

高龄患者复杂经皮冠状动脉介入治疗（PCI）的结果仍存在争议。本研究旨在评估接受超薄支架治疗左主干或冠状动脉分叉病变的高龄患者与年轻患者的临床结局。

方法

所有连续出现无保护左主干（ULM）或分叉处临界病变且接受超薄支架治疗的患者均纳入 RAIN（veRy thin stents for patients with left mAIn or bifurcatioN in real life）登记研究，并分为高龄组（OG，551 例）和非高龄组（NOG，2453 例）。主要不良心血管事件（MACE）是全因死亡、非致死性心肌梗死（MI）、靶病变血运重建（TLR）和支架血栓形成（ST）的复合终点，是主要终点，而 MACE 各组分、心血管（CV）死亡和靶血管血运重建（TVR）是次要终点。

结果

OG 中急性冠脉综合征占 64.7%，NOG 中占 53.1%。OG 中严重钙化和弥漫性病变明显更多。随访 15.2±10.3 个月后，OG 患者的 MACE 发生率高于 NOG 患者（OG 19.1% vs. NOG 11.2%，p<.001），MI（OG 6% vs. NOG 3.4%，p=0.002）和全因死亡（OG 14% vs. NOG 4.3%，p<.001）也是如此。然而，CV 死亡（OG 5.1% vs. NOG 4%，p=0.871）、TVR/TLR 或 ST 无显著差异。多变量分析显示，年龄不是 MACE 的独立预测因素（OR 1.02，95%CI 0.76-1.38），但与全因死亡、糖尿病、GFR<60ml/min 和 ULM 疾病相关。