Long-term outcomes of high-risk elderly male patients with multivessel coronary disease： optimal medical therapy versus revascularization

BackgroundMany 研究显示了那医药治疗和经皮的冠的干预与稳定的冠的动脉疾病以病人的长期的预后有类似的效果。这研究与高风险的 angina.MethodsIn 在老病人调查了最佳的医药治疗(OMT ) 和 revascularization-plus-OMT 的效果这未来的非使随机化的研究，有 angiographically 证实的 multivessel 疾病的 241 个连续高风险的老男病人(65-92 岁) 从 2004 年 1 月在登记被注册到 2005 年4月。这些， 98 个病人经历了 OMT ， 143 加后续的 OMT.ResultsAfter 6.5 年经历了 revascularization 治疗，我们发现长期的心脏的死亡的率在比在经历了 revascularization 的那些经历了 OMT 的病人是显著地更高的(6.5年的 unadjusted 死亡率，14.3%为 OMT 对7.0%为 revascularization 病人；木头等级 P = 0.04 ) 。然而，主要不利心脏的脑血管的事件(MACCE ) 的全面风险在所有病人之中是类似的(6.5 年的 unadjusted 死亡率， 29.6% 为 OMT 对 27.3% 为 revascularization 病人；木头等级 P = 0.67 ).ConclusionsOMT 与心脏的死亡的增加被联系但是 MACCE 的类似的 6.5 年的风险与在有冠的 multivessel 的高风险的老男病人的 revascularization 相比疾病。

Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.