Wang Shaoping, Lyu Yi, Cheng Shujuan, Liu Jinghua, Borah Bijan J
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
Ther Clin Risk Manag. 2021 Oct 15;17:1103-1111. doi: 10.2147/TCRM.S336713. eCollection 2021.
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are two revascularization strategies for patients with coronary artery disease (CAD) and left ventricular dysfunction. However, the comparisons of effectiveness between the two strategies are insufficient. This study is aimed to compare the effectiveness between PCI and CABG among patients with moderate left ventricular dysfunction.
A total of 1487 CAD patients with moderate reduced ejection fraction (36%≤EF≤40%), who underwent either PCI or CABG, were enrolled in a real-world cohort study (No. ChiCTR2100044378). Clinical outcomes included short- and long-term all-cause mortality, rates of heart failure (HF) hospitalization and repeat revascularization. Propensity score matching was used to balance the two cohorts.
PCI was associated with lower 30-day mortality rate (hazard ratio [HR] [95% CI], 0.35 [0.15-0.83]; =0.02). At a mean follow-up of 4.5 years, PCI and CABG had similar all-cause death (HR [95% CI], 0.82 [0.56-1.20]; =0.30) and heart failure (HF) hospitalization (HR [95% CI], 0.93 [0.54-1.60]; =0.79), but PCI had higher risk of repeat revascularization (HR [95% CI], 8.62 [3.67-20.23]; <0.001). Improvement in EF measured at 3 months later after revascularization was also similar between PCI and CABG ( for interaction=0.87).
CAD patients with moderate reduced EF who had PCI had lower short-term mortality rate but higher risk of repeat revascularization during follow-up than patients who had CABG. PCI showed comparable long-term survival, HF hospitalization risk, and EF improvement.
经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）是冠心病（CAD）合并左心室功能不全患者的两种血运重建策略。然而，这两种策略有效性的比较尚不充分。本研究旨在比较中度左心室功能不全患者中PCI和CABG的有效性。
共有1487例射血分数中度降低（36%≤EF≤40%）且接受了PCI或CABG的CAD患者纳入一项真实世界队列研究（编号ChiCTR2100044378）。临床结局包括短期和长期全因死亡率、心力衰竭（HF）住院率和再次血运重建率。采用倾向评分匹配法平衡两组队列。
PCI与较低的30天死亡率相关（风险比[HR][95%置信区间]，0.35[0.15 - 0.83]；P = 0.02）。在平均4.5年的随访中，PCI和CABG的全因死亡（HR[95%置信区间]，0.82[0.56 - 1.20]；P = 0.30）和心力衰竭（HF）住院情况（HR[95%置信区间]，0.93[0.54 - 1.60]；P = 0.79）相似，但PCI再次血运重建的风险更高（HR[95%置信区间]，8.62[3.67 - 20.23]；P < 0.001）。血运重建后3个月时测量的EF改善情况在PCI和CABG之间也相似（交互作用P = 0.87）。
与接受CABG的患者相比，中度EF降低的CAD患者接受PCI后短期死亡率较低，但随访期间再次血运重建的风险较高。PCI在长期生存、HF住院风险和EF改善方面表现相当。
