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Gennaro Giustino¹, Joseph F Sabik², Patrick W Serruys³

¹Gagnon Cardiovascular Institute, Atlantic Health System, Morristown, New Jersey, USA. Electronic address: https://twitter.com/g_giustinoMD.

Journal of the American College of Cardiology

|December 4, 2024

概括

在冠状动脉旁路移植 (CABG) 后,严重出血 (MB) 的发生率高于用于左主冠状动脉疾病的皮肤通冠状动脉干预 (PCI). 在任何一次重血管化手术后发生的MB事件都增加了5年内死亡的风险.

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
临床试验临床试验

背景情况:

左主冠状动脉疾病 (LMCAD) 重血管化后的主要出血 (MB) 发生率和预后影响尚不清楚.
穿皮冠状动脉干预 (PCI) 和冠状动脉旁路移植 (CABG) 是LMCAD的主要治疗方法.

研究的目的:

调查PCI与CABG的LMCAD重血管化后主要出血 (MB) 的发生率和结果.
评估MB与随后死亡率之间的关联.

主要方法:

从EXCEL试验中分析了1,905名没有受保护的LMCAD患者,随机分为PCI (n=948) 或CABG (n=957).
根据TIMI大/小,BARC类型3-5或需要输血的出血定义的MB;随访5年.
用于评估MB与死亡率的关联的时间调整的考克斯回归模型.

主要成果:

在5年后,11.4%的患者患有MB. 与PCI (7.9%) 相比,CABG的5年MB率 (14.8%) 较高.
住院时的MB在PCI (3.8%) 与CABG (13.5%) 相比较低,但出院后的MB在PCI (4.5%) 与CABG (2.0%) 相比较高.
5年内发生的MB事件显著增加了因心血管和非心血管原因导致的全因死亡风险 (HR: 2.71).

结论:

冠状动脉旁路移植 (CABG) 与较高的整体和在医院的大型出血 (MB) 率相比,与皮肤冠状动脉干预 (PCI) 相比,用于左侧主要冠状动脉疾病.
放电后的MB在PCI后比CABG更频繁.
随着LMCAD重血管化策略的重大出血后,独立预测5年内心血管和非心血管死亡率增加.

关键词:

流血出血流血出血冠状动脉绕道移植冠状动脉绕道移植左侧的主要冠状动脉.通过皮肤进行冠状动脉干预.预后预后预后

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