基于倾向性匹配评分的左主干病变预先置入IABP对比保守策略1年随访研究

A propensity score matched analysis for one year follow-up of IABP in left main artery disease compared with conservative strategy

目的:分析在左主干介入治疗中预先置入主动脉球囊反搏(IABP)对比保守策略的效果与安全性差异。方法:纳入2013年1月-2018年9月在北京朝阳医院行左主干介入治疗患者共237例。其中预先置入患者127例(预先置入组),未置入IABP110例(保守策略组)。观察两组患者术后1个月内主要心脏不良事件(MACE)、术后1年病死率、再次血运重建、再发心血管不良事件。结果:经倾向性匹配评分后,①预先置入组术后1个月内的MACE显著低于保守策略组(9.6%∶21.7%,P=0.033)。多因素Logistics回归分析表明双支架术式是MACE的独立危险因素(OR 3.026,95%CI:1.173~7.808,P=0.022);预先置入IABP是MACE的独立保护因素(OR 0.359,95%CI:0.143~0.900,P=0.029)。②两组患者1年MACE差异无统计学意义。③两组患者1年病死率的Kaplan-Meier曲线未见显著差异(log-rank P=0.665)。结论:在左主干病变的介入治疗中,预先置入IABP可减少术后1个月内的MACE的发生率,但不能降低远期病死率。

Objective:To compare the effectiveness and complication rates of IABP in left main artery percutaneous coronary interventional(PCI) therapy compared with conservative strategy.Method:A total of 237 patients received left main artery percutaneous coronary interventional therapy were selected.All patients were divided into provisional IABP group(n=127) and conservative group(n=110).The major adverse cardiac events(MACE),1-year mortality were observed.Result:After propensity score matched analysis,MACE in 1 month after PCI in the provivsional group was significant lower than in the conservative group(9.6% vs 21.7%,P=0.033).Multivariate logistic regression analysis showed that double stenting type was independent risk factor(OR 3.026,95%CI 1.173~7.808,P=0.022).IABP was an independent protective factor(OR 0.359,95%CI 0.143~0.900,P=0.029).There was no significant difference in 1-year cardiovascular adverse events,between the two groups.There was no significant difference in Kaplan Meier curve of 1-year mortality between the two groups(log rank P=0.665).Conclusion:In the PCI treatment of left main artery disease,IABP can reduce the incidence of MACE,but can not reduce the long-term mortality.