Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and Multivessel Coronary Disease.
Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Diabetes and Multivessel Coronary Disease.
复制标题
糖尿病和多人冠状动脉疾病患者的手术或经皮血运重建后的长期生存。
DOI：
10.1016/j.jacc.2020.06.052
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发表时间：
2020-09-08
影响因子：
24
通讯作者：
Lee DS
中科院分区：
文献类型：
--
作者：
Tam DY;Dharma C;Rocha R;Farkouh ME;Abdel-Qadir H;Sun LY;Wijeysundera HC;Austin PC;Udell JA;Gaudino M;Fremes SE;Lee DS
在糖尿病合并多支冠状动脉疾病(CAD)患者中，比较经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)的真实观察证据仍然很少。比较糖尿病患者经皮冠状动脉介入术和冠状动脉旁路移植术的近期和远期疗效。加拿大安大略省的临床和行政数据库被链接起来，以获得2008-2017年间所有有血管造影证据的糖尿病患者的记录，这些患者接受了经皮冠状动脉介入术或单独的冠状动脉搭桥术。进行1：1倾向评分匹配以说明基线差异。采用分层对数等级检验和COX比例风险模型比较两组的全因死亡率和心肌梗死、重复血管重建、中风或死亡(称为主要心脑血管事件[MACCE])的构成。共有4519名患者接受了经皮冠状动脉介入治疗，9716名患者接受了冠脉搭桥术。在配对前，CABG患者明显更年轻(65.7岁比68.3岁)，更有可能是男性(78%比73%)，并且有更严重的CAD。基于23个基线协变量的倾向性得分匹配产生了4301对平衡良好的配对。术后早期病死率分别为2.4%和2.3%，差异无统计学意义(P=0.721)。中位随访期5.5年，最长随访期11.5年。与冠脉搭桥术相比，经皮冠状动脉介入治疗的全因死亡率(危险比(HR)1.39，95%CI；1.28~1.51)和总体MACCE(HR 1.99，95%CI；1.86~2.12)显著高于CABG。在多支冠状动脉病变合并糖尿病的患者中，与经皮冠状动脉介入治疗相比，冠脉搭桥术与改善长期死亡率和摆脱MACCE有关。利用加拿大安大略省的临床和管理数据库，对4301对患有糖尿病和多支冠状动脉病变(CAD)的患者进行了倾向分数匹配分析，比较了经皮冠状动脉介入(PCI)和冠状动脉旁路移植术(CABG)。在早期死亡率方面，经皮冠状动脉介入术和冠脉搭桥术之间没有差异(2.4%比2.3%，p=0.721)，但在整个随访期间，经皮冠状动脉介入术的全因死亡率显著高于冠脉搭桥术(风险比：1.39，95%CI；1.28-1.51)。与冠脉搭桥术相比，经皮冠状动脉介入治疗的主要不良心脑血管事件的总体构成更高(HR：1.99，95%CI；1.86-2.12)。
There remains a paucity of real-world observational evidence comparing percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG) in patients with diabetes and multivessel coronary artery disease (CAD). To compare early and long-term outcomes of PCI versus CABG in patients with diabetes. Clinical and administrative databases in Ontario, Canada, were linked to obtain records of all diabetic patients with angiographic evidence of 2-vessel or 3-vessel CAD who were treated with either PCI or isolated CABG from 2008–2017. 1:1 propensity score matching was performed to account for baseline differences. All-cause mortality and the composite of myocardial infarction, repeat revascularization, stroke, or death (termed major cardiovascular and cerebrovascular events [MACCE]) were compared between the matched groups using a stratified log rank test and Cox-proportional hazards model. A total of 4,519 and 9,716 patients underwent PCI and CABG respectively. Prior to matching, CABG patients were significantly younger (65.7 vs 68.3 years), more likely male (78% vs 73%) and had more severe CAD. Propensity score matching based on 23 baseline covariates yielded 4,301 well-balanced pairs. There was no difference in early mortality between PCI and CABG (2.4% vs 2.3%, p=0.721) after matching. The median and maximum follow-up were 5.5 and 11.5 years respectively. All-cause mortality (hazard ratio (HR) 1.39, 95%CI; 1.28–1.51) and overall MACCE (HR 1.99, 95%CI; 1.86–2.12) were significantly higher with PCI compared to CABG. In patients with multivessel CAD and diabetes, compared to PCI, CABG was associated with improved long-term mortality and freedom from MACCE. A propensity score matched analysis comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in 4,301 patient-pairs with diabetes and multivessel coronary artery disease (CAD) was undertaken utilizing clinical and administrative databases housed in Ontario, Canada. While there was no difference in early mortality between PCI and CABG (2.4% vs 2.3%, p=0.721), the rate of all-cause mortality over the entire follow-up was significantly higher with PCI (hazard ratio (HR): 1.39, 95%CI; 1.28–1.51) compared to CABG. Overall composite of major adverse cardiac and cerebrovascular events was higher with PCI compared to CABG (HR: 1.99, 95%CI; 1.86–2.12).
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影响因子：
168.9
作者：
Daemen, Joost;Wenaweser, Peter;Serruys, Patrick W.
通讯作者：
Serruys, Patrick W.
DOI：
10.1161/circoutcomes.114.001416
发表时间：
2015-03-01
影响因子：
6.9
作者：
Tu, Jack V.;Chu, Anna;Stukel, Therese A.
通讯作者：
Stukel, Therese A.
影响因子：
--
作者：
Takagi, Hisato;Watanabe, Taku;Umemoto, Takuya
通讯作者：
Umemoto, Takuya
影响因子：
2
作者：
Austin PC;Fine JP
通讯作者：
Fine JP
影响因子：
2
作者：
Austin, Peter C.
通讯作者：
Austin, Peter C.