Effect of Patient-Reported Preprocedural Physical and Mental Health on 10-Year Mortality After Percutaneous or Surgical Coronary Revascularization
Effect of Patient-Reported Preprocedural Physical and Mental Health on 10-Year Mortality After Percutaneous or Surgical Coronary Revascularization
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DOI：
10.1161/circulationaha.121.057021
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发表时间：
2022-10-25
期刊：
影响因子：
37.8
通讯作者：
Onuma, Yoshinobu
中科院分区：
文献类型：
--
作者：
Ono, Masafumi;Serruys, Patrick W.;Onuma, Yoshinobu
背景：在患有复杂冠状动脉疾病（如左主干冠状动脉疾病或三支血管病变）的患者中，临床和解剖特征通常被视为决定经皮冠状动脉介入治疗（PCI）还是冠状动脉旁路移植术（CABG）的关键因素。然而，对于术前自我报告的身体/心理健康与血运重建后的临床结果之间的相互作用知之甚少。
方法：SYNTAXES试验（SYNTAX延长生存期）的这项亚组分析是随机SYNTAX试验（紫杉醇洗脱支架PCI与心脏手术的协同作用）的延长随访，该试验比较了左主干冠状动脉疾病或三支血管病变患者的PCI和CABG。根据术前36项简短健康调查问卷得出的身体成分总结（PCS）或精神成分总结（MCS）评分的三分位数对患者进行分层，PCS和MCS评分越高分别代表身体和心理健康状况越好。主要终点是10年时的全因死亡。
结果：本研究共纳入1656例有术前36项简短健康调查问卷数据的患者。较高的PCS和MCS均独立与较低的10年死亡率相关（PCS每增加10分，调整后的风险比为0.84[95%置信区间，0.73 - 0.97]；P = 0.021；MCS调整后的风险比为0.85[95%置信区间，0.76 - 0.95]；P = 0.005）。在PCS最高（>45.5）和MCS最高（>52.3）的三分位数中，观察到CABG相较于PCI有显著的生存优势，且存在显著的亚组 - 治疗交互作用（PCS交互作用P = 0.033，MCS交互作用P = 0.015）。在PCS（>45.5）和MCS（>52.3）均较高的患者中，与CABG相比，PCI的10年死亡率显著更高（30.5%对12.2%；风险比为2.87[95%置信区间，1.55 - 5.30]；P = 0.001），而在PCS较低（......）的患者中（此处原文似乎不完整）
BACKGROUND: Clinical and anatomical characteristics are often considered key factors in deciding between percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with complex coronary artery disease (CAD) such as left-main CAD or 3-vessel disease. However, little is known about the interaction between self-reported preprocedural physical/mental health and clinical outcomes after revascularization.METHODS: This subgroup analysis of the SYNTAXES trial (SYNTAX Extended Survival), which is the extended follow-up of the randomized SYNTAX trial (Synergy Between PCI With Taxus and Cardiac Surgery) comparing PCI with CABG in patients with left-main CAD or 3-vessel disease, stratified patients by terciles of Physical (PCS) or Mental Component Summary (MCS) scores derived from the preprocedural 36-Item Short Form Health Survey, with higher PCS and MCS scores representing better physical and mental health, respectively. The primary end point was all-cause death at 10 years.RESULTS: A total of 1656 patients with preprocedural 36-Item Short Form Health Survey data were included in the present study. Both higher PCS and MCS were independently associated with lower 10-year mortality (10-point increase in PCS adjusted hazard ratio, 0.84 [95% CI, 0.73-0.97]; P=0.021: in MCS adjusted hazard ratio, 0.85 [95% CI, 0.76-0.95]; P=0.005). A significant survival benefit with CABG over PCI was observed in the highest PCS (>45.5) and MCS (>52.3) terciles with significant treatment-by-subgroup interactions (PCS P-interaction=0.033, MCS P-interaction=0.015). In patients with both high PCS (>45.5) and MCS (>52.3), 10-year mortality was significantly higher with PCI compared with CABG (30.5% versus 12.2%; hazard ratio, 2.87 [95% CI, 1.55-5.30]; P=0.001), whereas among those with low PCS (