治疗时机对稳定型缺血性心脏病患者重复血管重建的影响

Sean Hardiman PhD, MHA , Guy Fradet MD, MSc , Lisa Kuramoto MSc , Michael Law PhD , Simon Robinson MB, ChB, MD , Boris Sobolev PhD
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引用次数: 0

摘要

目标在稳定型缺血性心脏病患者中,没有证据表明血管重建治疗时机对重复手术的需求有影响。我们旨在确定在医生建议的时间后接受冠状动脉旁路移植手术的患者与及时接受经皮冠状动脉介入治疗的患者相比,重复血管再通的情况是否有所不同。方法我们确定了 25520 名 60 岁或以上的不列颠哥伦比亚省居民,他们在 2001 年 1 月 1 日至 2016 年 12 月 31 日期间因血管造影证实的稳定型左主干或多支血管缺血性心脏病接受了首次非急诊血管再通治疗。与及时接受经皮冠状动脉介入治疗的患者相比,我们估算了延迟接受冠状动脉旁路移植术的患者在指数血管重建或最后一次分期经皮冠状动脉介入治疗后,在死亡作为竞争风险的情况下,重复血管重建的未调整和调整累积发病率函数。结果经治疗权重逆概率调整后,3 年后,与及时接受经皮冠状动脉介入治疗的患者相比,接受延迟冠状动脉旁路移植术的患者重复血管再通的累积发生率有显著统计学意义(4.结论与及时接受经皮冠状动脉介入治疗的患者相比,接受延迟冠状动脉旁路移植术的患者重复血管再通的累积发生率较低。希望等待接受冠状动脉搭桥术的患者将看到,与经皮冠状动脉介入治疗相比,延迟治疗带来的重复血管再通发生率较低的益处不受影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effect of treatment timing on repeat revascularization in patients with stable ischemic heart disease

Objectives

In patients with stable ischemic heart disease, there is no evidence for the effect of revascularization treatment timing on the need for repeat procedures. We aimed to determine if repeat revascularizations differed among patients who received coronary artery bypass graft surgery after the time recommended by physicians compared with those who had timely percutaneous coronary intervention.

Methods

We identified 25,520 British Columbia residents 60 years or older who underwent first-time nonemergency revascularization for angiographically proven, stable left main or multivessel ischemic heart disease between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted cumulative incidence functions for repeat revascularization, in the presence of death as a competing risk, after index revascularization or last staged percutaneous coronary intervention for patients undergoing delayed coronary artery bypass grafting compared with timely percutaneous coronary intervention.

Results

After adjustment with inverse probability of treatment weights, at 3 years, patients who underwent delayed coronary artery bypass grafting had a statistically significant lower cumulative incidence of a repeat revascularization compared with patients who received timely percutaneous coronary intervention (4.84% delayed coronary artery bypass grafting, 12.32% timely percutaneous coronary intervention; subdistribution hazard ratio, 0.16, 95% CI, 0.04-0.65).

Conclusions

Patients who undergo delayed coronary artery bypass grafting have a lower cumulative incidence of repeat revascularization than patients who undergo timely percutaneous coronary intervention. Patients who want to wait to receive coronary artery bypass grafting will see the benefit of lower repeat revascularization over percutaneous coronary intervention unaffected by a delay in treatment.

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