当代冠状动脉旁路移植术与多支血管经皮冠状动脉介入治疗比较。
Contemporary Coronary Artery Bypass Grafting vs Multivessel Percutaneous Coronary Intervention.
机构信息
Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia.
Department of Cardiovascular and Thoracic Surgery, WVU Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia.
出版信息
Ann Thorac Surg. 2023 Dec;116(6):1213-1220. doi: 10.1016/j.athoracsur.2023.05.032. Epub 2023 Jun 22.
BACKGROUND
Interpretation of recent alterations to the guideline priority of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel disease contests historical data and practice. To reevaluate contemporary outcomes, a large contemporary analysis was conducted comparing CABG with multivessel PCI among Medicare beneficiaries.
METHODS
The United States Centers for Medicare and Medicaid Services database was evaluated all beneficiaries with acute coronary syndrome undergoing isolated CABG or multivessel PCI (2018-2020). Risk adjustment was performed using multilevel regression analysis, Cox proportional hazards time to event models, and inverse probability of treatment weighting propensity scores.
RESULTS
A total of 104,127 beneficiaries were identified undergoing CABG (n = 51,389) or multivessel PCI (n = 52,738). Before risk adjustment, compared with PCI, CABG patients were associated with younger age (72.9 vs 75.2 years, P < .001), higher Elixhauser Comorbidity Index (5.0 vs 4.2, P < .001), more diabetes (48.5% vs 42.2%, P < .001), higher cost ($54,154 vs $33,484, P < .001), and longer length of stay (11.9 vs 5.8 days, P < .001). After inverse probability of treatment weighting propensity score adjustment, compared with PCI, CABG was associated with lower hospital mortality (odds ratio, 0.74; P < .001), fewer hospital readmissions at 3 years (odds ratio, 0.85; P < .001), fewer coronary reinterventions (hazard ratio, 0.37; P < .001), and improved 3-year survival (hazard ratio, 0.51; P < .001).
CONCLUSIONS
Contemporary real-world data from Medicare patients with multivessel disease reveal that CABG outcomes were superior to PCI, providing important longitudinal data to guide patient care and policy development.
背景
最近对冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）治疗多支血管疾病的指南优先级的解释与历史数据和实践相悖。为了重新评估当代的结果，对医疗保险受益人的 CABG 与多支血管 PCI 进行了一项大型的当代分析比较。
方法
评估了美国医疗保险和医疗补助服务中心数据库中所有接受急性冠状动脉综合征单独 CABG 或多支血管 PCI（2018-2020 年）的患者。使用多层次回归分析、Cox 比例风险时间事件模型和逆概率治疗加权倾向评分进行风险调整。
结果
共确定了 104127 名接受 CABG（n=51389）或多支血管 PCI（n=52738）的患者。在风险调整之前，与 PCI 相比，CABG 患者年龄更小（72.9 岁比 75.2 岁，P<0.001），合并症 Elixhauser 指数更高（5.0 比 4.2，P<0.001），糖尿病更多（48.5%比 42.2%，P<0.001），费用更高（54154 美元比 33484 美元，P<0.001），住院时间更长（11.9 天比 5.8 天，P<0.001）。经过逆概率治疗加权倾向评分调整后，与 PCI 相比，CABG 与较低的院内死亡率相关（比值比，0.74；P<0.001），3 年的再住院率较低（比值比，0.85；P<0.001），冠状动脉再介入较少（风险比，0.37；P<0.001），3 年生存率提高（风险比，0.51；P<0.001）。
结论
来自 Medicare 多支血管疾病患者的当代真实世界数据显示，CABG 的结果优于 PCI，为指导患者护理和政策制定提供了重要的纵向数据。
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