Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
J Interv Cardiol. 2020 May 7;2020:2139617. doi: 10.1155/2020/2139617. eCollection 2020.
We aim to evaluate the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with high-risk coronary anatomy (HRCA).
Coronary disease severity is important for therapeutic decision-making and prognostication among patients presenting with NSTE-ACS. However, long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with HRCA is still unknown.
NSTE-ACS patients undergoing PCI in Fuwai Hospital in 2013 were prospectively enrolled and subsequently divided into HRCA and low-risk coronary anatomy (LRCA) groups according to whether angiography complies with the HRCA definition. HRCA was defined as left main disease >50%, proximal LAD lesion >70%, or 2- to 3- vessel disease involving the LAD. Prognosis impact on 2-year and 5-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed.
Out of 4,984 enrolled patients with NSTE-ACS, 3,752 patients belonged to the HRCA group, while 1,232 patients belonged to the LRCA group. Compared with the LRCA group, patients in the HRCA group had worse baseline characteristics including higher age, more comorbidities, and worse angiographic findings. Patients in the HRCA group had higher incidence of unplanned revascularization (2 years: 9.7% vs. 5.1%, < 0.001; 5 years: 15.4% vs. 10.3%, < 0.001), 2-year MACCE (13.1% vs. 8.8%, < 0.001), and 5-year death/MI/revascularization/stroke (23.0% vs. 18.4%, = 0.001). Kaplan-Meier survival analysis showed similar results. After adjusting for confounding factors, HRCA is independently associated with higher risk of revascularization (2 years: HR = 1.636, 95% CI: 1.225-2.186; 5 years: HR = 1.460, 95% CI: 1.186-1.798), 2-year MACCE (HR = 1.275, 95% CI = 1.019-1.596) and 5-year death/MI/revascularization/stroke (HR = 1.183, 95% CI: 1.010-1.385).
In our large cohort of Chinese patients, HRCA is an independent risk factor for long-term unplanned revascularization and MACCE.
本研究旨在评估高风险冠状动脉解剖（HRCA）的非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）患者的长期预后。
对于 NSTE-ACS 患者，冠状动脉疾病的严重程度对于治疗决策和预后具有重要意义。然而，接受 HRCA 经皮冠状动脉介入治疗（PCI）患者的长期预后仍不清楚。
前瞻性纳入 2013 年在中国阜外医院接受 PCI 的 NSTE-ACS 患者，并根据是否符合 HRCA 定义将其分为 HRCA 和低风险冠状动脉解剖（LRCA）组。HRCA 定义为左主干病变>50%、近端左前降支（LAD）病变>70%或 2-3 支血管病变累及 LAD。分析 2 年和 5 年主要不良心脑血管事件（MACCE）的预后影响。
在纳入的 4984 例 NSTE-ACS 患者中，3752 例属于 HRCA 组，1232 例属于 LRCA 组。与 LRCA 组相比，HRCA 组患者的基线特征较差，包括年龄更大、合并症更多以及更差的血管造影结果。HRCA 组患者计划外血运重建的发生率更高（2 年：9.7%比 5.1%，<0.001；5 年：15.4%比 10.3%，<0.001）、2 年 MACCE（13.1%比 8.8%，<0.001）和 5 年死亡/心肌梗死/血运重建/卒中等复合终点事件（23.0%比 18.4%，=0.001）。Kaplan-Meier 生存分析也得到了类似的结果。在校正混杂因素后，HRCA 与更高的血运重建风险（2 年：HR=1.636，95%CI：1.225-2.186；5 年：HR=1.460，95%CI：1.186-1.798）、2 年 MACCE（HR=1.275，95%CI：1.019-1.596）和 5 年死亡/心肌梗死/血运重建/卒中等复合终点事件（HR=1.183，95%CI：1.010-1.385）独立相关。
在我们的大型中国患者队列中，HRCA 是长期计划外血运重建和 MACCE 的独立危险因素。
