经皮冠状动脉介入治疗左冠状动脉主干。所有患者 BIA-LM 登记的时间趋势和长期疗效。

IF 3.7 3区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Kardiologia polska Pub Date : 2024-10-08 DOI:10.33963/v.phj.102774
Emil Julian Dąbrowski, Sławomir Dobrzycki, Paweł Kralisz, Konrad Nowak, Kamil Gugała, Przemysław Prokopczuk, Grzegorz Mężyński, Michał Święczkowski, Łukasz Kuźma, Marcin Kożuch
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引用次数: 0

摘要

背景:经皮冠状动脉介入治疗(PCI)治疗左主干冠状动脉(LMCA)得到了试验的认可。目的:旨在评估真实世界登记中的预后和时间趋势。分析包括死亡率预测因素、年度和周期趋势(2007-2015 年与 2015-2022 年相比):中位年龄为71岁(IQR为16),736人(73.8%)为男性,448人(51.9%)患有多种疾病(≥3种慢性病)。预后较差与年龄≥75 岁(HR 1.61,95% CI 1.17-2.20,P=0.003)、心肌梗死(HR 1.47,95% 1.06-2.04,P=0.02)、既往心肌梗死(HR 1.43,95% CI 1.07-1.91,P=0.02)、糖尿病(HR 1.38,95% CI 1.03-1.84,P=0.03)、心房颤动(HR 1.74,95% CI 1.26-2.39,P=0.001)、慢性阻塞性肺病(HR 2.01,95% CI 1.27-3.20,P=0.003)和既往中风(HR 1.78,95% CI 1.17-2.70,P=0.007)。较高的射血分数(HR 0.98,95% CI 0.96-0.99,P=0.007)和曾中风(HR 1.78,95% CI 1.17-2.70,P=0.007):PCI和多病症发生率增加。短期死亡率下降,而30天后的预后恶化。PCI 技术的进步可能会改善早期预后,但应努力减轻多病负担。
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Percutaneous coronary intervention for left main coronary artery. Temporal trends and long-term outcomes from the all-comers BIA-LM registry.

Background: Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) was endorsed by trials.

Aims: Aim was to assess prognosis and temporal trends in real-world registry.

Methods: 998 patients undergoing LMCA PCI were hospitalized from 12.27.2007 to 02.21.2022. Analysis included mortality predictors, annual and periodic trends (2007-2015 compared to 2015-2022).

Results: Median age was 71 years (IQR 16), 736 (73.8%) were male and 448 (51.9%) had multimorbidity (≥3 chronic diseases). Worse prognosis was associated with age ≥75 years (HR 1.61, 95% CI 1.17-2.20, P=0.003), myocardial infarction (HR 1.47, 95% 1.06-2.04, P=0.02), previous myocardial infarction (HR 1.43, 95% CI 1.07-1.91, P=0.02), diabetes (HR 1.38, 95% CI 1.03-1.84, P=0.03), atrial fibrillation (HR 1.74, 95% CI 1.26-2.39, P=0.001), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.27-3.20, P=0.003) and previous stroke (HR 1.78, 95% CI 1.17-2.70, P=0.007). Higher ejection fraction (HR 0.98, 95% CI 0.96-0.99, P<0.001 for 1% increase) and intravascular imaging (HR 0.70, 95% CI 0.49-1.00, P=0.047) yielded better outcomes. Rate of LMCA PCI emerged from 2.2% in 2008 to 6.9% in 2021 (P<0.001). There were increases in annual and periodic rates of multimorbidity (P<0.001), intravascular imaging (P<0.001) and decreases in 30-, 90-day (log-rank P<0.001) and 1-year mortality (log-rank P=0.007). Six-year landmark mortality analysis at 30-days showed trend toward worse prognosis in patients hospitalized in late period (log-rank P=0.051).

Conclusions: PCI and multimorbidity rates increased. Short-term mortality decreased, while prognosis beyond 30-days worsened. Advancements in PCI technology may improve early outcomes; however, efforts should be made to reduce burden of multimorbidity.

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来源期刊
Kardiologia polska
Kardiologia polska 医学-心血管系统
CiteScore
3.00
自引率
24.20%
发文量
431
审稿时长
3-6 weeks
期刊介绍: Kardiologia Polska (Kardiol Pol, Polish Heart Journal) is the official peer-reviewed journal of the Polish Cardiac Society (PTK, Polskie Towarzystwo Kardiologiczne) published monthly since 1957. It aims to provide a platform for sharing knowledge in cardiology, from basic science to translational and clinical research on cardiovascular diseases.
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