Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.
Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Berlin, Germany.
Eur J Clin Invest. 2024 Dec;54(12):e14303. doi: 10.1111/eci.14303. Epub 2024 Aug 21.
Coronary artery disease (CAD) is a main cause of morbidity and mortality. The effectiveness of coronary revascularization in chronic coronary syndromes (CCS) is still debated. Our recent study showed the superiority of coronary revascularization over optimal medical therapy (OMT) in reducing cardiovascular (CV) mortality and myocardial infarction (MI). The recent publication of the ORBITA-2 trial suggested superiority of percutaneous coronary revascularization (PCI) in reducing angina and improving quality of life. Therefore, we aimed to provide an updated meta-analysis evaluating the impact of PCI on both clinical outcomes and angina in CCS.
Relevant studies were screened in PubMed/Medline until 08/01/2024. Randomized controlled trials (RCTs) comparing PCI to OMT in CCS were selected. The primary outcome was CV death. Secondary outcomes were MI, all-cause mortality, stroke, major bleeding and angina severity.
Nineteen RCTs involving 8616 patients were included. Median follow-up duration was 3.3 years. Revascularization significantly reduced CV death (4.2% vs. 5.5%; OR = .77; 95% CI .62-.96, p = .02). Subgroup analyses favoured revascularization in patients without chronic total occlusions (CTOs) (p = .052) and those aged <65 years (p = .02). Finally, a follow-up duration beyond 3 years showed increased benefit of coronary revascularization (p = .04). Secondary outcomes analyses showed no significant differences, except for a lower angina severity in the revascularization group according to the Seattle Angina Questionnaire (SAQ) (p = .04) and to the Canadian Cardiovascular Society (CCS) classification (p = .005).
PCI compared to OMT significantly reduces CV mortality and angina severity, improving quality of life in CCS patients. This benefit was larger without CTOs, in patients aged <65 years and with follow-up duration beyond 3 years.
冠心病（CAD）是发病率和死亡率的主要原因。在慢性冠状动脉综合征（CCS）中，冠状动脉血运重建的效果仍存在争议。我们最近的研究表明，与最佳药物治疗（OMT）相比，冠状动脉血运重建在降低心血管（CV）死亡率和心肌梗死（MI）方面具有优势。最近 ORBITA-2 试验的发表表明，经皮冠状动脉血运重建（PCI）在减轻心绞痛和改善生活质量方面具有优势。因此，我们旨在提供一项更新的荟萃分析，评估 PCI 对 CCS 患者的临床结局和心绞痛的影响。
在 PubMed/Medline 中筛选截至 2024 年 08 月 01 日的相关研究。选择比较 PCI 与 OMT 在 CCS 中的随机对照试验（RCT）。主要结局是 CV 死亡。次要结局是 MI、全因死亡率、卒中和主要出血以及心绞痛严重程度。
纳入了 19 项涉及 8616 名患者的 RCT。中位随访时间为 3.3 年。血运重建显著降低了 CV 死亡率（4.2%比 5.5%；OR=0.77；95%CI 0.62-0.96，p=0.02）。亚组分析有利于无慢性完全闭塞（CTO）（p=0.052）和年龄<65 岁的患者（p=0.02）进行血运重建。最后，随访时间超过 3 年显示出冠状动脉血运重建的获益增加（p=0.04）。次要结局分析显示，除了西雅图心绞痛问卷（SAQ）（p=0.04）和加拿大心血管学会（CCS）分类（p=0.005）显示血运重建组心绞痛严重程度较低外，无显著差异。
与 OMT 相比，PCI 显著降低了 CCS 患者的 CV 死亡率和心绞痛严重程度，改善了生活质量。这种益处在无 CTO 患者、年龄<65 岁的患者和随访时间超过 3 年的患者中更大。
