经冠状动脉旁路移植术或经皮冠状动脉介入治疗的缺血性心力衰竭患者的长期死亡率：来自瑞典冠状动脉造影和血管成形术登记处（SCAAR）的见解。

Long-term mortality in patients with ischaemic heart failure revascularized with coronary artery bypass grafting or percutaneous coronary intervention: insights from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).

机构信息

Department of Cardiology, Sahlgrenska University Hospital, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.

Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Bruna straket 16, 413 45 Gothenburg, Sweden.

出版信息

Eur Heart J. 2021 Jul 15;42(27):2657-2664. doi: 10.1093/eurheartj/ehab273.

AIMS

To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of patients with heart failure due to ischaemic heart disease.

METHODS AND RESULTS

We analysed all-cause mortality following CABG or PCI in patients with heart failure with reduced ejection fraction and multivessel disease (coronary artery stenosis >50% in ≥2 vessels or left main) who underwent coronary angiography between 2000 and 2018 in Sweden. We used a propensity score-adjusted logistic and Cox proportional-hazards regressions and instrumental variable model to adjust for known and unknown confounders. Multilevel modelling was used to adjust for the clustering of observations in a hierarchical database. In total, 2509 patients (82.9% men) were included; 35.8% had diabetes and 34.7% had a previous myocardial infarction. The mean age was 68.1 ± 9.4 years (47.8% were >70 years old), and 64.9% had three-vessel or left main disease. Primary designated therapy was PCI in 56.2% and CABG in 43.8%. Median follow-up time was 3.9 years (range 1 day to 10 years). There were 1010 deaths. Risk of death was lower after CABG than after PCI [odds ratio (OR) 0.62; 95% confidence interval (CI) 0.41-0.96; P = 0.031]. The risk of death increased linearly with quintiles of hospitals in which PCI was the preferred method for revascularization (OR 1.27, 95% CI 1.17-1.38, Ptrend < 0.001).

CONCLUSION

In patients with ischaemic heart failure, long-term survival was greater after CABG than after PCI.

目的

比较冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）治疗缺血性心脏病心力衰竭患者的效果。

方法和结果

我们分析了 2000 年至 2018 年期间在瑞典接受冠状动脉造影检查的射血分数降低和多血管疾病（≥2 支血管或左主干存在冠状动脉狭窄 >50%）的心力衰竭患者中，CABG 或 PCI 治疗后全因死亡率。我们使用倾向评分调整后的逻辑回归和 Cox 比例风险回归以及工具变量模型来调整已知和未知的混杂因素。使用多层次模型来调整分层数据库中观察结果的聚类。共纳入 2509 例患者（82.9%为男性）；35.8%患有糖尿病，34.7%有既往心肌梗死史。平均年龄为 68.1±9.4 岁（47.8%年龄 >70 岁），64.9%存在三支血管或左主干疾病。主要指定治疗方法为 PCI（56.2%）和 CABG（43.8%）。中位随访时间为 3.9 年（范围 1 天至 10 年）。共有 1010 例死亡。CABG 组的死亡风险低于 PCI 组[比值比（OR）0.62；95%置信区间（CI）0.41-0.96；P=0.031]。随着首选 PCI 作为血运重建方法的医院五分位数的增加，死亡风险呈线性增加（OR 1.27，95%CI 1.17-1.38，Ptrend <0.001）。