National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease (S.L., C.G., F.W., L.X., T.Z., Y.S., S.C., L.H., B.X., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery (S.L., Z.Z.), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Circ Cardiovasc Interv. 2022 Feb;15(2):e011312. doi: 10.1161/CIRCINTERVENTIONS.121.011312. Epub 2022 Feb 15.
Percutaneous coronary intervention (PCI) has been used increasingly as an alternative means of revascularization for patients with chronic total occlusion and multivessel disease. We investigated 5-year clinical outcomes following coronary artery bypass grafting (CABG) and PCI in patients with chronic total occlusion and multivessel disease.
In this single-center, retrospective cohort study, 4324 consecutive patients with ≥1 chronic total occlusion and multivessel disease were treated with either CABG (n=2264) or PCI (n=2060) between 2010 and 2013. The primary outcome was 5-year composite of death, myocardial infarction, or stroke. An inverse-probability-of-treatment weighting method was used adjusting for both patient and lesion characteristics.
The unadjusted 5-year composite outcomes were similar between CABG group and PCI group (12.1% [258/2264] versus 11.4% [218/2060]; =0.52). After adjustment for baseline variables, PCI was associated with significantly higher risk of composite outcomes (adjusted hazard ratio: 1.21 [95% CI, 1.02-1.44]; =0.03). The inferiority of PCI in 5-year composite outcome was significant in patients with CABG recommendation according to SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score II (adjusted hazard ratio: 1.55 [95% CI, 1.14-2.09]; =0.005) but not evident in patients with PCI or PCI/CABG equipoise recommendation according to SYNTAX score II (adjusted hazard ratio: 0.94 [95% CI, 0.75-1.17]; =0.56). A similar risk of 5-year composite outcomes was observed between CABG and PCI with residual SYNTAX score ≤8.
In this single-center retrospective study among patients with chronic total occlusion and multivessel disease, PCI was associated with higher risk of 5-year composite death, myocardial infarction, or stroke.
经皮冠状动脉介入治疗（PCI）已越来越多地被用作慢性完全闭塞和多血管病变患者血运重建的替代方法。我们研究了慢性完全闭塞和多血管病变患者接受冠状动脉旁路移植术（CABG）和 PCI 后 5 年的临床结果。
在这项单中心回顾性队列研究中，2010 年至 2013 年间，4324 例至少有 1 处慢性完全闭塞和多血管病变的患者接受了 CABG（n=2264）或 PCI（n=2060）治疗。主要结局为死亡、心肌梗死或卒中等 5 年复合终点。采用逆概率治疗加权法调整患者和病变特征。
CABG 组和 PCI 组未校正的 5 年复合结局相似（12.1%[258/2264]vs.11.4%[218/2060]；=0.52）。在调整基线变量后，PCI 与复合结局的风险显著增加相关（校正后的危险比：1.21[95%可信区间，1.02-1.44]；=0.03）。在根据 SYNTAX 评分（经皮冠状动脉介入治疗与 Taxus 和心脏手术之间的协同作用）为 CABG 推荐的患者中，PCI 在 5 年复合结局方面的劣势显著（校正后的危险比：1.55[95%可信区间，1.14-2.09]；=0.005），但在根据 SYNTAX 评分为 PCI 或 PCI/CABG 均衡推荐的患者中并不明显（校正后的危险比：0.94[95%可信区间，0.75-1.17]；=0.56）。在残余 SYNTAX 评分≤8 的患者中，CABG 和 PCI 的 5 年复合结局风险相似。
在这项多血管病变慢性完全闭塞患者的单中心回顾性研究中，PCI 与 5 年复合死亡、心肌梗死或卒中等风险增加相关。
