Bytyçi Ibadete, Morina Defrim, Bytyqi Sefer, Bajraktari Gani, Henein Michael Y
Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo.
Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umea, Sweden.
J Clin Med. 2023 Feb 9;12(4):1395. doi: 10.3390/jcm12041395.
(1) Background and Aim: Conflicting evidence exists regarding the benefits of percutaneous coronary intervention (PCI) on survival and symptomatic relief of patients with chronic coronary syndrome (CCS) compared with optimal medical therapy (OMT). This meta-analysis is to evaluate the short- and long-term clinical benefit of PCI over and above OMT in CCS. (2) Methods: Main endpoints were major adverse cardiac events (MACEs), all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), urgent revascularization, stroke hospitalization, and quality of life (QoL). Clinical endpoints at very short (≤3 months), short- (<12 months), and long-term (≥ 12 months) follow-up were evaluated. (3) Results: Fifteen RCTs with a total of 16,443 patients with CCS (PCI = 8307 and OMT = 8136) were included in the meta-analysis. At mean follow-up of 27.7 months, the PCI group had similar risk of MACE (18.2 vs. 19.2 %; < 0.32), all-cause mortality (7.09 vs. 7.88%; = 0.56), CV mortality (8.74 vs. 9.87%; = 0.30), MI (7.69 vs. 8.29%; = 0.32), revascularization (11.2 vs. 18.3%; = 0.08), stroke (2.18 vs. 1.41%; = 0.10), and hospitalization for anginal symptoms (13.5 vs. 13.9%; = 0.69) compared with OMT. These results were similar at short- and long-term follow-up. At the very short-term follow-up, PCI patients had greater improvement in the QoL including physical limitation, angina frequency, stability, and treatment satisfaction ( < 0.05 for all) but such benefits disappeared at the long-term follow-up. (4) Conclusions: PCI treatment of CCS does not provide any long-term clinical benefit compared with OMT. These results should have significant clinical implications in optimizing patient's selection for PCI treatment.
(1) 背景与目的：与最佳药物治疗（OMT）相比，经皮冠状动脉介入治疗（PCI）对慢性冠状动脉综合征（CCS）患者生存及症状缓解的益处存在相互矛盾的证据。本荟萃分析旨在评估PCI相对于OMT在CCS中的短期和长期临床益处。(2) 方法：主要终点为主要不良心脏事件（MACE）、全因死亡率、心血管（CV）死亡率、心肌梗死（MI）、紧急血运重建、卒中住院率及生活质量（QoL）。评估了极短期（≤3个月）、短期（<12个月）和长期（≥12个月）随访时的临床终点。(3) 结果：荟萃分析纳入了15项随机对照试验，共16443例CCS患者（PCI组 = 8307例，OMT组 = 8136例）。平均随访27.7个月时，PCI组与OMT组相比，MACE风险相似（18.2%对19.2%；P<0.32）、全因死亡率相似（7.09%对7.88%；P = 0.56）、CV死亡率相似（8.74%对9.87%；P = 0.30）、MI相似（7.69%对8.29%；P = 0.32）、血运重建相似（11.2%对18.3%；P = 0.08）、卒中相似（2.18%对1.41%；P = 0.10）以及因心绞痛症状住院相似（13.5%对13.9%；P = 0.69）。短期和长期随访结果相似。在极短期随访时，PCI患者的QoL在身体限制、心绞痛频率、稳定性和治疗满意度方面有更大改善（均P<0.05）但这些益处长期随访时消失。(4) 结论：与OMT相比，PCI治疗CCS未提供任何长期临床益处。这些结果对优化PCI治疗患者选择具有重要临床意义。
