摘要
目的:比较冠状动脉(冠脉)伴或不伴左主干病变的三支病变患者接受再血管化治疗(REV)和保守治疗(MT)的长期预后。方法:连续入选我院在2007-01至2008-12间经择期冠脉造影发现的伴或不伴左主干病变的4 875例三支病变患者。其中705例(14.4%)患者为MT组,4 170例(85.6%)患者接受了REV为REV组。经倾向评分的逆概率加权方法调整使其基线均衡后,比较两组患者在随访中全因死亡率以及再血管化率。结果:在4 875例患者中,3 962例(81.2%)为单纯三支(右冠脉、左前降支、左回旋支)病变,913例(18.8%)患者为三支合并左主干病变。两组患者住院死亡率差异没有统计学意义[比值比(OR)=0.7,95%可信区间(CI):0.3-1.4;P=0.30]。随访中位数为1年,MT组经校正的全因死亡率显著高于REV组[风险比(HR)=8.3,95%CI:6.7-11.1;P〈0.001],再血管化率也显著高于REV组(HR=1.4,95%CI:1.1-1.6;P〈0.001)。无论是否合并左主干病变,与REV相比,MT组的全因死亡率均明显较高(合并左主干:HR=10.4,95%CI:7.1-15.4,P〈0.001;单纯三支:HR=7.1,95%CI:5.3-10.0;P〈0.001)。结论:在真实世界中,对于择期冠脉造影发现的伴或不伴左主干病变的三支病变患者,经REV的长期预后明显优于MT。
Objective: To compare the long term prognosis between revascularization (REV) and medical therapy (MP) in patients with three-vessel disease (3VD) with or without left main (LM) lesion. Methods: A total of 4,875 consecutive patients with elective coronary angiography (CAG) diagnosed 3VD with or without LM lesion treated in our hospital from 2007-01 to 2008-12 were retrospectively studied. The patients were divided into 2 groups: MT group, n=705 (14.5%) and REV group, n=4170 (85.5%). The all cause mortality and the rate of revascularization during follow-up period were compared between 2 groups by inverse-probability-weighting approach with propensity score. Results: There were 3962/4875 (81.3%) patients with simple 3VD (right, left anterior descending and left circumflex coronary arteries) and 913 (18.7%) with 3VD+LM lesion. The in-hospital mortality was similar between 2 groups (OR=0.7, 95% CI 0.3-1.4, P=0.30). With the longest 2-year follow-up study, the adjusted all cause mortality and the rate of revascularization in MT group were both higher than those in REV group (HR=8.3, 95% CI 6.7-11.1, P〈0.001) and (HR=1.4, 95% CI 1.1-1.6, P〈0.001). No matter the patients with simple 3 VD or 3 VD+LM lesion, compared with REV group, MT group had the higher all cause mortality, for 3VD+LM lesion (HR=10.4, 95% CI 7.1-15.4, P〈0.001) and for simple 3VD (HR=7.1, 95% CI 5.3-10.0, P〈0.001). Conclusion: In real world, the long term prognosis by revascularization treatment was superior to medical treatment inpatients with either simple 3 vessel coronary disease or 3 vessel combining LM disease.
出处
《中国循环杂志》
CSCD
北大核心
2015年第8期733-736,共4页
Chinese Circulation Journal
基金
国际科技合作项目(2010DFB33140)
"十二五"国家科技支撑计划项目(2011BAI11B21
2011BAI11B02)
卫生部公益专项基金项目(200902001)
新世纪优秀人才支持计划