缺血性心脏病中经皮冠状动脉介入治疗和冠状动脉旁路移植术的健康状况结局
Health Status Outcomes With Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting in ISCHEMIA.
作者信息
Huded Chetan P, Spertus John A, Jones Philip G, O'Brien Sean M, Mark Daniel B, Bangalore Sripal, Stone Gregg W, Williams David O, White Harvey D, Boden William E, Reynolds Harmony R, Hochman Judith S, Maron David J
机构信息
Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., J.A.S., P.G.J.).
University of Missouri-Kansas City's Healthcare Institute for Innovations in Quality (C.P.H., J.A.S., P.G.J.).
出版信息
Circulation. 2025 Sep 23;152(12):846-858. doi: 10.1161/CIRCULATIONAHA.125.073591. Epub 2025 Sep 5.
BACKGROUND
In ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), an invasive strategy demonstrated better health status outcomes than a conservative strategy in patients with chronic coronary disease (CCD). Some previous studies have shown greater health status benefits with coronary artery bypass grafting (CABG) than percutaneous coronary intervention (PCI). Whether the health status benefits of invasive management in ISCHEMIA were driven primarily by participants treated with CABG is unknown.
METHODS
The aim of this analysis was to describe the health status outcomes of participants treated with a conservative strategy (n=2232) compared with invasively managed participants treated with PCI (n=1198) or CABG (n=340) in ISCHEMIA. The Seattle Angina Questionnaire-7 summary score (SAQ-SS) and angina frequency score (SAQ-AF) were the primary outcomes, with higher scores indicating better health status. Proportional odds models comparing 1- and 3-year outcomes were fit, adjusting for demographic, clinical, and angiographic characteristics.
RESULTS
SAQ-SS in the conservative, PCI, and CABG groups increased by 9.9±18.1, 15.7±19.3, and 16.1±19.1 points at 1 year and 11.5±20.2, 16.5±21.8, and 15.0±19.4 points at 3 years, respectively. Freedom from angina in the conservative, PCI, and CABG groups was noted in 61.4%, 73.3%, and 82.4% at 1 year and 70.4%, 76.1%, 81.4% at 3 years, respectively. In risk-adjusted analyses, PCI and CABG were each associated with a higher SAQ-SS and SAQ-AF at 1 and 3 years compared with conservative management. SAQ-AF was higher with CABG than PCI at 1 year (odds ratio, 1.54 [95% CI, 1.03, 2.31]), but no differences between CABG and PCI were observed in SAQ-SS (odds ratio, 1.11 [95% CI, 0.78, 1.57]) or SAQ-AF (odds ratio, 0.94 [95% CI, 0.58, 1.54]) at 3 years.
CONCLUSIONS
In ISCHEMIA, both PCI and CABG were associated with better 3-year health status than conservative management. Better angina relief with CABG than PCI was seen at 1, but not 3, years.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
背景
在缺血性心脏病（采用药物和侵入性治疗方法的比较健康效果国际研究，简称ISCHEMIA）中，对于慢性冠状动脉疾病（CCD）患者，侵入性治疗策略比保守治疗策略能带来更好的健康状况结果。先前的一些研究表明，冠状动脉旁路移植术（CABG）比经皮冠状动脉介入治疗（PCI）能给健康状况带来更大益处。ISCHEMIA中侵入性治疗在健康状况方面的益处是否主要由接受CABG治疗的参与者所驱动尚不清楚。
方法
本分析的目的是描述ISCHEMIA中接受保守治疗策略的参与者（n = 2232）与接受PCI治疗（n = 1198）或CABG治疗（n = 340）的侵入性治疗参与者的健康状况结果。西雅图心绞痛问卷-7总结评分（SAQ-SS）和心绞痛频率评分（SAQ-AF）是主要结局指标，分数越高表明健康状况越好。采用比例优势模型比较1年和3年的结局，并对人口统计学、临床和血管造影特征进行调整。
结果
保守治疗组、PCI治疗组和CABG治疗组的SAQ-SS在1年时分别增加了9.9±18.1、15.7±19.3和16.1±19.1分，在3年时分别增加了11.5±20.2、16.5±21.8和15.0±19.4分。保守治疗组、PCI治疗组和CABG治疗组在1年时无心绞痛的比例分别为61.4%、73.3%和82.4%，在3年时分别为70.4%、76.1%和81.4%。在风险调整分析中，与保守治疗相比，PCI和CABG在1年和3年时均与更高的SAQ-SS和SAQ-AF相关。CABG在1年时的SAQ-AF高于PCI（优势比，1.54[95%CI，1.03，2.31]），但在3年时，CABG和PCI在SAQ-SS（优势比，1.11[95%CI，0.78，1.57]）或SAQ-AF（优势比，0.94[95%CI，0.58，1.54]）方面未观察到差异。
结论
在ISCHEMIA中，与保守治疗相比，PCI和CABG在3年时均与更好的健康状况相关。CABG在1年时比PCI能更好地缓解心绞痛，但在3年时并非如此。
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