Prognostic role of restenosis in 10 004 patients undergoing routine control angiography after coronary stenting
Prognostic role of restenosis in 10 004 patients undergoing routine control angiography after coronary stenting
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DOI：
10.1093/eurheartj/ehu383
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发表时间：
2015-01-01
影响因子：
39.3
通讯作者：
Kastrati, Adnan
中科院分区：
文献类型：
--
作者：
Cassese, Salvatore;Byrne, Robert A.;Kastrati, Adnan
常规冠状动脉造影是诊断冠状动脉支架置入术后再狭窄的一种高灵敏度的有价值的方法。然而，再狭窄的预后作用仍有争议。我们研究了在慕尼黑，德国的两个中心1998年至2009年因原发病变成功植入冠状动脉支架并在6-8个月后进行常规对照血管造影的患者中，再狭窄对4年死亡率的影响。再狭窄定义为随访血管造影时节段内区域直径狭窄<千分之一> 50%。主要结局为4年死亡率。该研究纳入了10004例患者的15004处治疗病变。在2643例（26.4%）患者中检测到呼吸暂停。随访期间共有702例死亡。其中，218例死亡发生在再狭窄患者中，484例死亡发生在无再狭窄患者中[未校正的风险比：HR：1.19;（95%置信区间CI：1.02-1.40）; P = 0.03]。调整其他变量的考克斯比例风险模型将再狭窄确定为4年死亡率的独立相关因素[HR：1.23;（95% CI：1.03-1.46）; P = 0.02]。4年死亡率的其他独立相关因素是年龄[每增加10年，HR：2.34;（95% CI：2.12-2.60）; P < 0.001]，糖尿病[HR：1.68;（95% CI：1.41-1.99）; P < 0.001]，目前吸烟习惯[HR：1.39;（95% CI：1.09-1.76）; P = 0.01]，左室射血分数[每降低5%，HR：1.39;（95%CI：1.31-1.48）; P < 0.001]。在这个大的患者队列中，冠状动脉支架术后随访血管造影时再狭窄的存在预示着4年死亡率。冠状动脉支架术后常规对照血管造影是否有益并影响预后，应通过适当设计的随机试验进行评价。
Routine control angiography is a valuable tool with high-sensitivity in detecting restenosis after coronary stenting. However, the prognostic role of restenosis is still controversial. We investigated the impact of restenosis on 4-year mortality in patients undergoing routine control angiography after coronary stenting.All the patients undergoing successful implantation of coronary stents for de novo lesions from 1998 to 2009 and routine control angiography after 6-8 months at two centres in Munich, Germany were studied. Restenosis was defined as diameter stenosis a parts per thousand yen50% in the in-segment area at follow-up angiography. The primary outcome was 4-year mortality. The study included 10 004 patients with 15 004 treated lesions. Restenosis was detected in 2643 (26.4%) patients. Overall, there were 702 deaths during the follow-up. Of these, 218 deaths occurred among patients with restenosis and 484 deaths occurred among patients without restenosis [unadjusted hazard ratio: HR: 1.19; (95% confidence interval CI: 1.02-1.40); P = 0.03]. The Cox proportional hazards model adjusting for other variables identified restenosis as an independent correlate of 4-year mortality [HR: 1.23; (95% CI: 1.03-1.46); P = 0.02]. Other independent correlates of 4-year mortality were age [for each 10-year increase, HR: 2.34; (95% CI: 2.12-2.60); P < 0.001], diabetes mellitus [HR: 1.68; (95% CI: 1.41-1.99); P < 0.001], current smoking habit [HR: 1.39; (95% CI: 1.09-1.76); P = 0.01], and left ventricular ejection fraction [for each 5% decrease, HR: 1.39; (95% CI: 1.31-1.48); P < 0.001].In this large cohort of patients, the presence of restenosis at follow-up angiography after coronary stenting was predictive of 4-year mortality. Whether routine control angiography after coronary stenting is beneficial and influences outcomes should be evaluated by properly designed randomized trials.