Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Heart. 2024 Oct 28;110(22):1307-1315. doi: 10.1136/heartjnl-2024-324307.
Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone.
We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality.
After PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding.
In this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.
经皮冠状动脉介入治疗（PCI）常用于慢性冠状动脉综合征（CCS）患者。然而，PCI 在 CCS 中除了缓解症状以外的作用仍存在争议。本研究旨在确定与单独药物治疗（MT）相比，PCI 是否与更好的结局相关。
我们进行了一项回顾性队列研究。我们使用瑞典冠状动脉血管造影和血管成形术登记处，纳入了 2010 年至 2020 年间在瑞典接受冠状动脉造影的所有 CCS 患者。根据治疗策略将患者分为两组：PCI+MT 组与 MT 组。采用 1:1 倾向评分（PS）匹配来解决混杂因素。使用匹配赢比分析来评估结局，这是一种按临床重要性对复合结局进行排序的统计方法。主要结局为 5 年内净不良临床事件（NACE）。在赢比分析中，NACE 的组成部分按照以下顺序排列：（1）全因死亡率，（2）心肌梗死（MI），（3）出血和（4）紧急血运重建。次要结局为 NACE、主要不良心血管事件（MACE）和心血管死亡率的各个组成部分。
PS 匹配后，每组各纳入 7220 例患者。NACE 和 MACE 的分层结局分析显示，PCI 与改善结局相关（匹配赢比：1.28（95%CI 1.20 至 1.36，p<0.001）和匹配赢比：1.38（95%CI 1.29 至 1.48，p<0.001））。使用 PCI 与更高的 MI（匹配赢比：1.15（95%CI 1.04 至 1.28，p=0.008）、紧急血运重建（匹配赢比：1.85（95%CI 1.69 至 2.03，p<0.001）和心血管死亡率（匹配赢比：1.15（95%CI 1.00 至 1.34，p=0.044）的赢比相关。全因死亡率或出血的赢比无差异。
在这项使用分层方法评估 CCS 患者结局的研究中，选择接受 PCI 血运重建的患者与单独 MT 相比，结局更好。
