多部位动脉疾病对经皮冠状动脉介入治疗后临床结局的影响：来自 e-Ultimaster 登记研究的分析。
Impact of multisite artery disease on clinical outcomes after percutaneous coronary intervention: an analysis from the e-Ultimaster registry.
机构信息
Technion-Faculty of Medicine, Hillel Yaffe Medical Center, Ha-Shalom St Hadera 3810101, Israel.
Thoraxcentrum Twente, Medisch Spectrum Twente, 7512 KZ Enschede, the Netherlands.
出版信息
Eur Heart J Qual Care Clin Outcomes. 2023 Jun 21;9(4):417-426. doi: 10.1093/ehjqcco/qcac043.
BACKGROUND
Multisite artery disease is considered a 'malignant' type of atherosclerotic disease associated with an increased cardiovascular risk, but the impact of multisite artery disease on clinical outcomes after percutaneous coronary intervention (PCI) is unknown.
METHODS
Patients enrolled in the large, prospective e-Ultimaster study were grouped into (1) those without known prior vascular disease, (2) those with known single-territory vascular disease, and (3) those with known two to three territories (i.e coronary, cerebrovascular, or peripheral) vascular disease (multisite artery disease). The primary outcome was coronary target lesion failure (TLF), defined as the composite of cardiac death, target vessel-related myocardial infarction, and clinically driven target lesion revascularization at 1-year. Inverse propensity score weighted (IPSW) analysis was performed to address differences in baseline patient and lesion characteristics.
RESULTS
Of the 37 198 patients included in the study, 62.3% had no prior known vascular disease, 32.6% had single-territory vascular disease, and 5.1% had multisite artery disease. Patients with known vascular disease were older and were more likely to be men and to have more co-morbidities. After IPSW, the TLF rate incrementally increased with the number of diseased vascular beds (3.16%, 4.44%, and 6.42% for no, single, and multisite artery disease, respectively, P < 0.01 for all comparisons). This was also true for all-cause death (2.22%, 3.28%, and 5.29%, P < 0.01 for all comparisons) and cardiac mortality (1.26%, 1.91%, and 3.62%, P ≤ 0.01 for all comparisons).
CONCLUSIONS
Patients with previously known vascular disease experienced an increased risk of adverse cardiovascular events and mortality post-PCI. This risk is highest among patients with multisite artery disease.
UNLABELLED
Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02188355.
背景
多部位动脉疾病被认为是一种与心血管风险增加相关的“恶性”动脉粥样硬化疾病，但多部位动脉疾病对经皮冠状动脉介入治疗（PCI）后临床结局的影响尚不清楚。
方法
在这项大型前瞻性 e-Ultimaster 研究中，将入组患者分为（1）无已知既往血管疾病，（2）已知单部位血管疾病，（3）已知两个至三个部位（即冠状动脉、脑血管或外周血管）血管疾病（多部位动脉疾病）。主要终点是冠状动脉靶病变失败（TLF），定义为 1 年时的心脏死亡、靶血管相关心肌梗死和临床驱动的靶病变血运重建的复合终点。采用逆概率评分加权（IPSW）分析来解决基线患者和病变特征的差异。
结果
在纳入研究的 37198 例患者中，62.3%无既往已知血管疾病，32.6%有单部位血管疾病，5.1%有多部位动脉疾病。已知血管疾病患者年龄较大，更可能为男性，合并症更多。经 IPSW 校正后，TLF 发生率随病变血管床数量的增加而逐渐增加（无血管疾病、单部位血管疾病和多部位动脉疾病的发生率分别为 3.16%、4.44%和 6.42%，所有比较 P<0.01）。全因死亡（2.22%、3.28%和 5.29%，所有比较 P<0.01）和心脏性死亡率（1.26%、1.91%和 3.62%，所有比较 P≤0.01）也是如此。
结论
既往有血管疾病的患者 PCI 后发生不良心血管事件和死亡的风险增加。这种风险在多部位动脉疾病患者中最高。
未加标签
Zotero 插件