慢性冠状动脉综合征经皮冠状动脉介入治疗加药物治疗与单纯药物治疗的对比:瑞典冠状动脉造影和血管成形术注册中心的倾向得分匹配分析。

IF 5.1 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Heart Pub Date : 2024-10-28 DOI:10.1136/heartjnl-2024-324307
Sacharias von Koch, Sasha Koul, Per Grimfjärd, Jonas Andersson, Tomas Jernberg, Elmir Omerovic, Ole Fröbert, David Erlinge, Moman A Mohammad
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引用次数: 0

摘要

背景:经皮冠状动脉介入治疗(PCI)常用于慢性冠状动脉综合征(CCS)患者。然而,PCI 在缓解慢性冠脉综合征症状之外的作用仍存在争议。本研究旨在确定与单纯药物治疗(MT)相比,PCI 是否能带来更好的疗效:我们进行了一项回顾性队列研究。我们利用瑞典冠状动脉造影和血管成形术登记处,纳入了 2010 年至 2020 年期间在瑞典接受冠状动脉造影术的所有 CCS 患者。根据治疗策略分为两组:PCI+MT组与单纯MT组。采用一对一倾向评分(PS)匹配来解决混杂问题。结果采用匹配胜率分析法进行评估,该统计方法根据临床重要性对综合结果的组成部分进行排序。主要结果是 5 年内的净不良临床事件 (NACE)。在胜率分析中,NACE 的各组成部分排序如下:(1)全因死亡率;(2)心肌梗死(MI);(3)出血;(4)紧急血运重建。次要结果是NACE的各个组成部分、主要不良心血管事件(MACE)和心血管死亡率:经过PS配对,两组各有7220名患者。对 NACE 和 MACE 的分层结果分析表明,PCI 与预后的改善相关(匹配成功率:1.28(95% CI 1.20 至 1.36,pConclusions):本研究旨在采用分层方法评估 CCS 患者的预后,与单纯 MT 相比,选择 PCI 进行血管重建的患者预后更好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome: a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry.

Background: Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone.

Methods: We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality.

Results: After PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding.

Conclusions: In this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.

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来源期刊
Heart
Heart 医学-心血管系统
CiteScore
10.30
自引率
5.30%
发文量
320
审稿时长
3-6 weeks
期刊介绍: Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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