经皮冠状动脉介入治疗左主干冠状动脉。来自全人群BIA-LM注册研究的时间趋势和长期结果。

Percutaneous coronary intervention for left main coronary artery. Temporal trends and long-term outcomes from the all-comer BIA-LM registry.

作者信息

Dąbrowski Emil Julian, Dobrzycki Sławomir, Kralisz Paweł, Nowak Konrad, Gugała Kamil, Prokopczuk Przemysław, Mężyński Grzegorz, Święczkowski Michał, Kuźma Łukasz, Kożuch Marcin

机构信息

Department of Invasive Cardiology, Medical University of Bialystok, Białystok, Poland.

出版信息

Kardiol Pol. 2024;82(12):1247-1258. doi: 10.33963/v.phj.102774. Epub 2024 Oct 8.

DOI:10.33963/v.phj.102774

PMID:39377622

Abstract

BACKGROUND

Percutaneous coronary intervention (PCI) for the left main coronary artery (LMCA) was endorsed by trials.

AIMS

This article aimed to assess prognosis and temporal trends in a real-world registry.

METHODS

In total, 998 patients undergoing LMCA PCI were hospitalized from December 27, 2007 to February 21, 2022. The analysis included mortality predictors, annual and periodic trends assessments (2007-2015 compared to 2015-2022).

RESULTS

The median age of patients was 71 years (interquartile range 16); 736 (73.8%) were male, and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.17-2.20; P = 0.003), myocardial infarction (HR, 1.47; 95% CI, 1.06-2.04; P = 0.02), previous myocardial infarction (HR, 1.43; 95% CI, 1.07-1.91; P = 0.02), diabetes (HR, 1.38; 95% CI, 1.03-1.84; P = 0.03), atrial fibrillation (HR, 1.74; 95% CI, 1.26-2.39; P = 0.001), chronic obstructive pulmonary disease (HR, 2.01; 95% CI, 1.27-3.20; P = 0.003), and previous stroke (HR, 1.78; 95% CI, 1.17-2.70; P = 0.007). Higher ejection fraction (HR, 0.98; 95% CI, 0.96-0.99; P <0.001 for 1% increase) and intravascular imaging (HR, 0.70; 95% CI, 0.49-1.00; P = 0.047) yielded better outcomes. The rate of LMCA PCI increased from 2.2% in 2008 to 6.9% in 2021 (P <0.001). There were increases in annual and periodic multimorbidity rates (P <0.001), intravascular imaging (P <0.001), and decreases in 30-, 90-day (log-rank P <0.001) and 1-year mortality (log-rank P = 0.007). Six-year landmark mortality analysis at 30 days showed a trend toward worse prognosis in patients hospitalized in the late period (log-rank P = 0.051).

CONCLUSIONS

PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30 days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce multimorbidity burden.

摘要

背景

经皮冠状动脉介入治疗（PCI）用于左主干冠状动脉（LMCA）已得到试验认可。

目的

本文旨在评估一个真实世界登记处中的预后情况和时间趋势。

方法

2007年12月27日至2022年2月21日期间，共有998例行LMCA PCI的患者住院。分析包括死亡率预测因素、年度和周期性趋势评估（2007 - 2015年与2015 - 2022年对比）。

结果

患者的中位年龄为71岁（四分位间距16）；736例（73.8%）为男性，448例（51.9%）患有多种疾病（≥3种慢性病）。预后较差与年龄≥75岁（风险比[HR]，1.61；95%置信区间[CI]，1.17 - 2.20；P = 0.003）、心肌梗死（HR，1.47；95% CI，1.06 - 2.04；P = 0.02）、既往心肌梗死（HR，1.43；95% CI，1.07 - 1.91；P = 0.02）、糖尿病（HR，1.38；95% CI，1.03 - 1.84；P = 0.03）、心房颤动（HR，1.74；95% CI，1.26 - 2.39；P = 0.001）、慢性阻塞性肺疾病（HR，2.01；95% CI，1.27 - 3.20；P = 0.003）以及既往卒中（HR，1.78；95% CI，1.17 - 2.70；P = 0.007）相关。较高的射血分数（HR，0.98；95% CI，0.96 - 0.99；射血分数每增加1%，P <0.001）和血管内成像（HR，0.70；95% CI，0.49 - 1.00；P = 0.047）可产生更好的结果。LMCA PCI的比例从2008年的2.2%增至2021年的6.9%（P <0.001）。年度和周期性多种疾病发生率（P <0.001）、血管内成像（P <0.001）有所增加，30天、90天（对数秩检验P <0.001）和1年死亡率有所降低（对数秩检验P = 0.007）。30天的六年标志性死亡率分析显示，后期住院患者的预后有变差趋势（对数秩检验P = 0.051）。