Hardiman Sean, Fradet Guy, Kuramoto Lisa, Law Michael, Robinson Simon, Sobolev Boris
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
JTCVS Open. 2024 Apr 22;19:164-174. doi: 10.1016/j.xjon.2024.04.009. eCollection 2024 Jun.
In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed among patients who received coronary artery bypass graft surgery after the time recommended by physicians compared with those who had timely percutaneous coronary intervention.
We identified 25,520 British Columbia residents 60 years or older who underwent first-time nonemergency revascularization for angiographically proven, stable left main or multivessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged percutaneous coronary intervention for patients undergoing delayed coronary artery bypass grafting compared with timely percutaneous coronary intervention.
After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed coronary artery bypass grafting had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely percutaneous coronary intervention (4.84% delayed coronary artery bypass grafting, 12.32% timely percutaneous coronary intervention; subdistribution hazard ratio, 0.16, 95% CI, 0.04-0.65).
Patients who undergo delayed coronary artery bypass grafting have a lower cumulative incidence of repeat revascularization than patients who undergo timely percutaneous coronary intervention. Patients who want to wait to receive coronary artery bypass grafting will see the benefit of lower repeat revascularization over percutaneous coronary intervention unaffected by a delay in treatment.
在稳定性缺血性心脏病患者中，尚无证据表明血运重建治疗时机对再次手术需求有影响。我们旨在确定，与及时接受经皮冠状动脉介入治疗的患者相比，在医师建议时间之后接受冠状动脉旁路移植术的患者再次血运重建情况是否存在差异。
我们确定了25520名60岁及以上的不列颠哥伦比亚居民，他们在2001年1月1日至2016年12月31日期间因血管造影证实的稳定性左主干或多支血管缺血性心脏病接受了首次非急诊血运重建。对于接受延迟冠状动脉旁路移植术的患者与及时接受经皮冠状动脉介入治疗的患者，我们估计了在存在死亡作为竞争风险的情况下，首次血运重建或最后一次分期经皮冠状动脉介入治疗后再次血运重建的未调整和调整后的累积发病率函数。
在用治疗权重的逆概率进行调整后，在3年时，接受延迟冠状动脉旁路移植术的患者再次血运重建的累积发病率在统计学上显著低于接受及时经皮冠状动脉介入治疗的患者（延迟冠状动脉旁路移植术为4.84%，及时经皮冠状动脉介入治疗为12.32%；亚分布风险比为0.16，95%CI为0.04-0.65）。
接受延迟冠状动脉旁路移植术的患者再次血运重建的累积发病率低于接受及时经皮冠状动脉介入治疗的患者。想要等待接受冠状动脉旁路移植术的患者将看到，与不受治疗延迟影响的经皮冠状动脉介入治疗相比，再次血运重建率较低的益处。
