Zizhao Qi, Miaohan Qiu, Ying Xu, Kai Xu, Haiwei Liu, Xiaozeng Wang, Jing Li, Bin Liu, Shaoliang Chen, Jiyan Chen, Yaling Han, Yi Li
{"title":"稳定期冠状动脉疾病患者有创与保守治疗的比较结果：一项基于风险分层的假设生成研究","authors":"Zizhao Qi, Miaohan Qiu, Ying Xu, Kai Xu, Haiwei Liu, Xiaozeng Wang, Jing Li, Bin Liu, Shaoliang Chen, Jiyan Chen, Yaling Han, Yi Li","doi":"10.1186/s12916-025-04020-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores.</p><p><strong>Methods: </strong>This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding.</p><p><strong>Results: </strong>The conservative group comprised 1767 (58.0%) patients and the invasive group comprised 1278 (42.0%) patients. Overall, invasive strategy did not reduce the risk of ischemic events compared with conservative strategy but was associated with an increased risk of BARC 2, 3, or 5 bleeding (adjusted hazard ratio (HR), 1.59; 95% confidence interval (CI), 1.13-2.26; P = 0.009). Similar results were observed in the low-risk patient subset (N = 2030). While in the moderate-to-high-risk subset (N = 1015), invasive strategy was associated with a reduced risk of ischemic events (HR, 0.67; 95% CI, 0.48-0.95; P = 0.02) and all-cause death (HR, 0.73; 95% CI, 0.51-1.03; P = 0.07), and with no excessive risk of bleeding.</p><p><strong>Conclusions: </strong>Invasive strategy could not confer additional clinical benefits in patients with SCAD compared to conservative strategy, except in patients at moderate-to-high risk. The OPT-CAD risk score may be valuable to the guidance of optimal treatment strategy in SCAD patients.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"199"},"PeriodicalIF":7.0000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974019/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative outcomes of invasive versus conservative strategy in stable coronary artery disease patients: a risk-stratification-based hypothesis-generative study.\",\"authors\":\"Zizhao Qi, Miaohan Qiu, Ying Xu, Kai Xu, Haiwei Liu, Xiaozeng Wang, Jing Li, Bin Liu, Shaoliang Chen, Jiyan Chen, Yaling Han, Yi Li\",\"doi\":\"10.1186/s12916-025-04020-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores.</p><p><strong>Methods: </strong>This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding.</p><p><strong>Results: </strong>The conservative group comprised 1767 (58.0%) patients and the invasive group comprised 1278 (42.0%) patients. Overall, invasive strategy did not reduce the risk of ischemic events compared with conservative strategy but was associated with an increased risk of BARC 2, 3, or 5 bleeding (adjusted hazard ratio (HR), 1.59; 95% confidence interval (CI), 1.13-2.26; P = 0.009). Similar results were observed in the low-risk patient subset (N = 2030). While in the moderate-to-high-risk subset (N = 1015), invasive strategy was associated with a reduced risk of ischemic events (HR, 0.67; 95% CI, 0.48-0.95; P = 0.02) and all-cause death (HR, 0.73; 95% CI, 0.51-1.03; P = 0.07), and with no excessive risk of bleeding.</p><p><strong>Conclusions: </strong>Invasive strategy could not confer additional clinical benefits in patients with SCAD compared to conservative strategy, except in patients at moderate-to-high risk. 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Comparative outcomes of invasive versus conservative strategy in stable coronary artery disease patients: a risk-stratification-based hypothesis-generative study.
Background: Whether percutaneous coronary intervention (PCI) can improve the long-term prognosis of patients with stable coronary artery disease (SCAD) in comparison to conservative treatment remains controversial. The present study sought to evaluate the impacts of initial invasive versus conservative strategy on long-term clinical outcomes for patients with SCAD stratified by risk scores.
Methods: This was a sub-analysis of the multicenter, observational Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT-CAD) study. Clinical outcomes were compared in SCAD patients who initially received PCI (invasive strategy) or conservative treatment according to risk stratification by OPT-CAD score. The primary outcome was ischemic events at 5 years, composed of cardiac death, myocardial infarction, and ischemic stroke. Secondary outcomes included all-cause death, Bleeding Academic Research Consortium (BARC) types 2, 3, or 5, and 3 or 5 bleeding.
Results: The conservative group comprised 1767 (58.0%) patients and the invasive group comprised 1278 (42.0%) patients. Overall, invasive strategy did not reduce the risk of ischemic events compared with conservative strategy but was associated with an increased risk of BARC 2, 3, or 5 bleeding (adjusted hazard ratio (HR), 1.59; 95% confidence interval (CI), 1.13-2.26; P = 0.009). Similar results were observed in the low-risk patient subset (N = 2030). While in the moderate-to-high-risk subset (N = 1015), invasive strategy was associated with a reduced risk of ischemic events (HR, 0.67; 95% CI, 0.48-0.95; P = 0.02) and all-cause death (HR, 0.73; 95% CI, 0.51-1.03; P = 0.07), and with no excessive risk of bleeding.
Conclusions: Invasive strategy could not confer additional clinical benefits in patients with SCAD compared to conservative strategy, except in patients at moderate-to-high risk. The OPT-CAD risk score may be valuable to the guidance of optimal treatment strategy in SCAD patients.
期刊介绍：
BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.
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