{"title":"外周动脉疾病对严重冠状动脉疾病患者经皮冠状动脉介入治疗与冠状动脉旁路移植术后长期疗效的影响","authors":"","doi":"10.1016/j.jjcc.2023.12.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>There is a scarcity of data evaluating the effect of peripheral artery disease (PAD) on long-term mortality after percutaneous coronary intervention (PCI) relative to </span>coronary artery bypass grafting<span> (CABG) in patients with severe coronary artery disease in real-world practice.</span></p></div><div><h3>Methods</h3><p><span><span><span>Among 14,867 consecutive patients who underwent their first coronary revascularization with PCI or isolated CABG between 2011 and 2013 in the CREDO-Kyoto PCI/CABG registry Cohort-3, the current study population consisted of 3380 patients with three-vessel </span>coronary artery disease or </span>left main coronary artery disease. Long-term clinical outcomes were compared between PCI and CABG stratified by the presence or </span>absence of PAD. Median clinical follow-up was 5.9 (IQR: 5.1–6.8) years.</p></div><div><h3>Results</h3><p>There were 461 patients with PAD (PCI: N = 307, CABG: N = 154), and 2919 patients without PAD (PCI: N = 1823, CABG: N = 1096). The cumulative 5-year mortality after coronary revascularization was 31.2 % in patients with PAD and 16.2 % in those without PAD (<em>p</em> < 0.0001). There was a higher risk of PCI relative to CABG for all-cause death in patients with and without PAD (adjusted HR, 1.59; 95%CI, 0.99–2.53; <em>p</em> = 0.054, and HR, 1.25; 95%CI, 1.01–1.56; <em>p</em> = 0.04) without interaction (<em>p</em> interaction <em>p</em> = 0.48); Nevertheless, there was no excess risk of PCI relative to CABG for cardiovascular death regardless of PAD.</p></div><div><h3>Conclusions</h3><p>The long-term mortality after coronary revascularization was significantly higher in severe CAD patients with PAD than those without PAD. There was a higher mortality risk of PCI relative to CABG in patients with and without PAD without interaction, which was mainly driven by excess non-cardiovascular deaths.</p></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effects of peripheral artery disease on long-term outcomes after percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe coronary artery disease\",\"authors\":\"\",\"doi\":\"10.1016/j.jjcc.2023.12.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p><span>There is a scarcity of data evaluating the effect of peripheral artery disease (PAD) on long-term mortality after percutaneous coronary intervention (PCI) relative to </span>coronary artery bypass grafting<span> (CABG) in patients with severe coronary artery disease in real-world practice.</span></p></div><div><h3>Methods</h3><p><span><span><span>Among 14,867 consecutive patients who underwent their first coronary revascularization with PCI or isolated CABG between 2011 and 2013 in the CREDO-Kyoto PCI/CABG registry Cohort-3, the current study population consisted of 3380 patients with three-vessel </span>coronary artery disease or </span>left main coronary artery disease. Long-term clinical outcomes were compared between PCI and CABG stratified by the presence or </span>absence of PAD. Median clinical follow-up was 5.9 (IQR: 5.1–6.8) years.</p></div><div><h3>Results</h3><p>There were 461 patients with PAD (PCI: N = 307, CABG: N = 154), and 2919 patients without PAD (PCI: N = 1823, CABG: N = 1096). The cumulative 5-year mortality after coronary revascularization was 31.2 % in patients with PAD and 16.2 % in those without PAD (<em>p</em> < 0.0001). There was a higher risk of PCI relative to CABG for all-cause death in patients with and without PAD (adjusted HR, 1.59; 95%CI, 0.99–2.53; <em>p</em> = 0.054, and HR, 1.25; 95%CI, 1.01–1.56; <em>p</em> = 0.04) without interaction (<em>p</em> interaction <em>p</em> = 0.48); Nevertheless, there was no excess risk of PCI relative to CABG for cardiovascular death regardless of PAD.</p></div><div><h3>Conclusions</h3><p>The long-term mortality after coronary revascularization was significantly higher in severe CAD patients with PAD than those without PAD. There was a higher mortality risk of PCI relative to CABG in patients with and without PAD without interaction, which was mainly driven by excess non-cardiovascular deaths.</p></div>\",\"PeriodicalId\":15223,\"journal\":{\"name\":\"Journal of cardiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2023-12-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0914508723003064\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0914508723003064","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景在现实世界中,评估严重冠状动脉疾病患者经皮冠状动脉介入治疗(PCI)相对于冠状动脉旁路移植术(CABG)后外周动脉疾病(PAD)对长期死亡率影响的数据很少。方法在CREDO-Kyoto PCI/CABG登记队列-3的14867名连续患者中,有3380名患有三血管冠状动脉疾病或左主干冠状动脉疾病,他们在2011年至2013年间接受了首次PCI或孤立CABG冠状动脉血运重建术。根据是否存在 PAD,比较了 PCI 和 CABG 的长期临床疗效。中位临床随访时间为5.9年(IQR:5.1-6.8年)。结果461例患者有PAD(PCI:307例,CABG:154例),2919例患者无PAD(PCI:1823例,CABG:1096例)。PAD患者冠状动脉血运重建后的5年累计死亡率为31.2%,而非PAD患者为16.2%(p < 0.0001)。在有 PAD 和无 PAD 的患者中,PCI 相对于 CABG 的全因死亡风险更高(调整后 HR,1.59;95%CI,0.99-2.53;p = 0.054,HR,1.25;95%CI,1.01-1.56;p = 0.04),且无交互作用(交互作用 p = 0.结论有 PAD 的严重 CAD 患者冠状动脉血运重建后的长期死亡率显著高于无 PAD 患者。在有 PAD 和无 PAD 的患者中,PCI 相对于 CABG 有更高的死亡风险,但两者之间没有交互作用,这主要是由于非心血管死亡过多所致。
Effects of peripheral artery disease on long-term outcomes after percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe coronary artery disease
Background
There is a scarcity of data evaluating the effect of peripheral artery disease (PAD) on long-term mortality after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG) in patients with severe coronary artery disease in real-world practice.
Methods
Among 14,867 consecutive patients who underwent their first coronary revascularization with PCI or isolated CABG between 2011 and 2013 in the CREDO-Kyoto PCI/CABG registry Cohort-3, the current study population consisted of 3380 patients with three-vessel coronary artery disease or left main coronary artery disease. Long-term clinical outcomes were compared between PCI and CABG stratified by the presence or absence of PAD. Median clinical follow-up was 5.9 (IQR: 5.1–6.8) years.
Results
There were 461 patients with PAD (PCI: N = 307, CABG: N = 154), and 2919 patients without PAD (PCI: N = 1823, CABG: N = 1096). The cumulative 5-year mortality after coronary revascularization was 31.2 % in patients with PAD and 16.2 % in those without PAD (p < 0.0001). There was a higher risk of PCI relative to CABG for all-cause death in patients with and without PAD (adjusted HR, 1.59; 95%CI, 0.99–2.53; p = 0.054, and HR, 1.25; 95%CI, 1.01–1.56; p = 0.04) without interaction (p interaction p = 0.48); Nevertheless, there was no excess risk of PCI relative to CABG for cardiovascular death regardless of PAD.
Conclusions
The long-term mortality after coronary revascularization was significantly higher in severe CAD patients with PAD than those without PAD. There was a higher mortality risk of PCI relative to CABG in patients with and without PAD without interaction, which was mainly driven by excess non-cardiovascular deaths.
期刊介绍:
The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.