Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
Cardiology. 2021;146(4):409-418. doi: 10.1159/000515376. Epub 2021 Apr 13.
In the treatment of left main coronary artery (LMCA) disease, patients' age may affect the clinical outcome after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study stratified the clinical outcome according to the age of patients treated for LMCA stenosis with PCI or CABG in the Nordic-Baltic-British Left Main Revascularization (NOBLE) study.
Patients with LMCA disease were enrolled in 36 centers in northern Europe and randomized 1:1 to treatment by PCI or CABG. Eligible patients had stable angina pectoris, unstable angina pectoris, or non-ST elevation myocardial infarction. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), a composite of all-cause mortality, nonprocedural myocardial infarction, any repeat coronary revascularization, and stroke. Age-stratified analysis was performed for the groups younger and older than 67 years and for patients older than 80 years.
For patients ≥67 years, the 5-year MACCEs were 35.7 versus 22.3% (hazard ratio [HR] 1.72 [95% confidence interval [CI] 1.27-2.33], p = 0.0004) for PCI versus CABG. The difference in MACCEs was driven by more myocardial infarctions (10.8 vs. 3.8% HR 3.01 [95% CI 1.52-5.96], p = 0.0009) and more repeat revascularizations (19.5 vs. 10.0% HR 2.01 [95% CI 1.29-3.12], p = 0.002). In patients younger than 67 years, MACCE was 20.5 versus 15.3% (HR 1.38 [95% CI 0.93-2.06], p = 0.11 for PCI versus CABG. All-cause mortality was similar after PCI and CABG in both age-groups. On multivariate analysis, age was a predictor of MACCE, along with PCI, diabetes, and SYNTAX score.
As the overall NOBLE results show revascularization of LMCA disease, age of 67 years or older was associated with lower 5-year MACCE after CABG compared to PCI. Clinical outcomes were not significantly different in the subgroup younger than 67 years, although no significant interaction was present between age and treatment. Mortality was similar for all subgroups (ClinicalTrials.gov identifier: NCT01496651).
在左主干冠状动脉（LMCA）疾病的治疗中，患者的年龄可能会影响经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）后的临床结果。本研究根据北欧-波罗的海-英国左主干血运重建（NOBLE）研究中接受 LMCA 狭窄 PCI 或 CABG 治疗的患者年龄对临床结果进行分层。
36 个北欧中心的 LMCA 疾病患者被纳入并按 1:1 随机分配接受 PCI 或 CABG 治疗。符合条件的患者有稳定型心绞痛、不稳定型心绞痛或非 ST 段抬高型心肌梗死。主要心脏或脑血管不良事件（MACCE）是所有原因死亡、非手术性心肌梗死、任何再次冠状动脉血运重建和卒中的复合终点。对年龄小于 67 岁和大于 80 岁的患者进行年龄分层分析。
对于年龄≥67 岁的患者，5 年 MACCE 分别为 35.7%和 22.3%（HR 1.72[95%CI 1.27-2.33]，p = 0.0004），PCI 与 CABG 相比。MACCE 的差异是由更多的心肌梗死（10.8%与 3.8%，HR 3.01[95%CI 1.52-5.96]，p = 0.0009）和更多的再次血运重建（19.5%与 10.0%，HR 2.01[95%CI 1.29-3.12]，p = 0.002）引起的。在年龄小于 67 岁的患者中，5 年 MACCE 分别为 20.5%和 15.3%（HR 1.38[95%CI 0.93-2.06]，p = 0.11，PCI 与 CABG 相比。两组的全因死亡率在 PCI 和 CABG 后相似。多变量分析显示，年龄与 PCI、糖尿病和 SYNTAX 评分一样，是 MACCE 的预测因素。
正如整体 NOBLE 结果所示，LMCA 疾病的血运重建，67 岁或以上患者与 CABG 相比，PCI 后 5 年 MACCE 较低。在年龄小于 67 岁的亚组中，临床结局无显著差异，尽管年龄与治疗之间无显著交互作用。所有亚组的死亡率相似（ClinicalTrials.gov 标识符：NCT01496651）。
