接受单纯冠状动脉旁路移植术的左主干病变患者和无左主干病变患者的临床事件发生率：来自欧洲 DuraGraft 登记处的结果。

Clinical event rate in patients with and without left main disease undergoing isolated coronary artery bypass grafting: results from the European DuraGraft Registry.

机构信息

Charité Universitätsmedizin Berlin, Berlin, Germany.

German Heart Center Berlin, Berlin, Germany.

出版信息

Eur J Cardiothorac Surg. 2022 Sep 2;62(4). doi: 10.1093/ejcts/ezac403.

DOI:10.1093/ejcts/ezac403

PMID:35929787

Abstract

OBJECTIVES

Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft Registry to investigate clinical event rates at 1 year in patients with and without LMCAD undergoing isolated CABG in contemporary practice.

METHODS

Patients undergoing isolated CABG were selected. The primary end point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1 year. The secondary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching was performed to balance for differences in baseline characteristics.

RESULTS

LMCAD was present in 1033 (41.2%) and absent in 1477 (58.8%) patients. At 1 year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, P = 0.002) driven by higher rates of death (5.4% vs 3.4%, P = 0.016), MI (3.0% vs 1.3%, P = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, P = 0.13). The incidence of MACCE was 8.8% vs 6.6%, P = 0.043, with a stroke rate of 1.0% and 2.4%, P = 0.011, for the LMCAD and non-LMCAD groups, respectively. After propensity score matching, the MACE rate was 8.0% vs 5.2%, P = 0.015. The incidence of death was 5.1% vs 3.7%, P = 0.10, MI 3.0% vs 1.4%, P = 0.020, and RR was 2.7% vs 1.6%, P = 0.090, for the LMCAD and non-LMCAD groups, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, P = 0.017). The MACCE rate was not different, 8.5% vs 6.7%, P = 0.12.

CONCLUSIONS

In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT02922088.

摘要

目的

左主干冠状动脉疾病（LMCAD）被认为是冠状动脉旁路移植术（CABG）后临床事件的独立危险因素。我们对多中心欧洲 DuraGraft 注册中心进行了亚组分析，以调查在当代实践中接受单纯 CABG 的有和无 LMCAD 的患者在 1 年时的临床事件发生率。

方法

选择接受单纯 CABG 的患者。主要终点是主要不良心脏事件（MACE）的发生率，定义为死亡、心肌梗死（MI）或重复血运重建（RR）的复合终点，在 1 年内。次要终点是主要不良心脏和脑血管事件（MACCE），定义为 MACE 加上卒中。采用倾向评分匹配来平衡基线特征的差异。

结果

LMCAD 患者 1033 例（41.2%），无 LMCAD 患者 1477 例（58.8%）。在 1 年时，LMCAD 患者的 MACE 发生率更高（8.2% vs 5.1%，P=0.002），死亡率（5.4% vs 3.4%，P=0.016）、MI（3.0% vs 1.3%，P=0.002）更高，RR 发生率（2.8% vs 1.8%，P=0.13）也更高。MACCE 的发生率为 8.8% vs 6.6%，P=0.043，LMCAD 组和非 LMCAD 组的卒中发生率分别为 1.0%和 2.4%，P=0.011。经过倾向评分匹配后，MACE 发生率为 8.0% vs 5.2%，P=0.015。LMCAD 组和非 LMCAD 组的死亡率分别为 5.1% vs 3.7%，P=0.10，MI 发生率分别为 3.0% vs 1.4%，P=0.020，RR 发生率分别为 2.7% vs 1.6%，P=0.090。LMCAD 组的卒中发生率较低（1.0% vs 2.4%，P=0.017）。MACCE 发生率无差异，8.5% vs 6.7%，P=0.12。