对于左主冠状动脉疾病进行PCI或CABG:SWEDEHEART注册表
Jonas Persson1, Jacinth Yan2, Oskar Angerås3
1Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Entrevägen 2, 182 88 Stockholm, Sweden.
European heart journal
|June 8, 2023
概括
冠状动脉旁路移植 (CABG) 与未受保护的左主冠状动脉疾病 (LMCA) 的皮肤冠状动脉干预 (PCI) 相比,与更好的生存率有关. CABG还导致较少的重大心血管不良事件,特别是在糖尿病患者中.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 不受保护的左主冠状动脉疾病 (LMCA) 具有重大风险.
- 冠状动脉旁路移植 (CABG) 和穿皮冠状动脉干预 (PCI) 是主要的治疗选择.
- 对LMCA疾病的比较结果数据对于临床决策至关重要.
研究的目的:
- 为了比较CABG与PCI在未受保护的LMCA疾病患者的长期结果.
- 分析死亡率,心肌梗塞,中风和复血管化率的差异.
- 研究糖尿病对治疗结果的影响.
主要方法:
- 观察性,全国范围的,全新入学者前性登记册研究.
- 利用瑞典网络系统,加强和发展根据推疗法注册 (2005-2015年) 评估的心脏病的基于证据的护理.
- 使用考克斯回归与反向概率加权 (IPW) 和仪表变量 (IV) 分析来调整混因子.
主要成果:
- 与PCI相比,CABG与显著降低的死亡率和重大心血管和脑血管不良事件 (MACCE) 有关.
- IPW分析显示,PCI死亡风险比率 (HR) 更高 (HR 2.0,95% CI 1.5-2.7).
- 静脉注射分析显示,糖尿病患者的中位生存时间更长,有利于糖尿病患者的CABG (3.6年长).
结论:
- 在未受保护的LMCA疾病中,CABG在死亡率和MACCE方面显示出优异的结果,与PCI相比.
- CABG的益处在糖尿病患者中尤为明显.
- 这些发现支持CABG作为不受保护的LMCA疾病的首选重血管化策略.
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