Efficacy comparison of 3 strategies for real-world stable coronary artery disease patients with three-vessel disease
10.3760/cma.j.issn.0253-3758.2017.12.009
- VernacularTitle: 稳定性冠心病三支病变患者三种治疗策略对比分析
- Author:
Ru LIU
1
;
Lin JIANG
;
Lianjun XU
;
Jian TIAN
;
Xueyan ZHAO
;
Yin ZHANG
;
Jingjing XU
;
Ying SONG
;
Huanhuan WANG
;
Zhan GAO
;
Lei SONG
;
Jinqing YUAN
Author Information
1. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China
- Publication Type:Clinical Trail
- Keywords:
Coronary disease;
Angioplasty;
Coronary artery bypass
- From:
Chinese Journal of Cardiology
2017;45(12):1049-1057
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the effectiveness of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical therapy (MT) alone for real-world stable coronary artery disease (SCAD) patients with three-vessel disease (TVD) in mainland China.
Methods:A total of 8 943 consecutive cases with TVD hospitalized in our center from April 2004 to February 2011 were screened for this study. In this cohort, 3 435 cases diagnosed as SCAD were analyzed. PCI, CABG, MT alone were performed in 1 313 (38.2%), 1 259 (36.7%) and 863 (25.1%) patients, respectively. Propensity score matching (PSM) analysis using nearest neighbor matching with a 1∶1 ratio was applied, and 758 pairs of CABG and PCI groups, 552 pairs of PCI and MT groups, 639 pairs of CABG and MT groups were selected, respectively. 1- and 2-year clinical outcomes were evaluated among PCI, CABG and MT group. Kaplan-Meier curves and multivariable Cox regression method were used for survival analysis.
Results:Significant differences were found at baseline between PCI, CABG and MT group, including age, gender, body mass index, family history of coronary artery disease, hyperlipidemia, diabetes mellitus, previous myocardial infarction, stroke, previous revascularization, peripheral vascular disease, SNYTAX score, left ventricular ejection fraction, hemoglobin, serum creatinine, high-sensitivity C-reactive protein, triglyceride and medication (all P<0.05) . All-cause death rates of 1- and 2-year follow-up of PCI, CABG and MT group were 0.6% (8/1 313), 1.1% (14/1 259), 3.4% (29/863) (P<0.001) and 1.1%(14/1 313), 1.5%(19/1 259), 7.3%(63/863) (P<0.001), respectively. Multivariate Cox regression analysis showed that 1-year MACCE rate (HR=0.51, 95%CI 0.33-0.77, P=0.001) was significantly reduced, due to the significant decrease of myocardial infarction (MI) rate (HR=0.09, 95%CI 0.01-0.76, P=0.027) and repeat revascularization rate (HR=0.21, 95%CI 0.10-0.41, P<0.001) in CABG group compared to PCI group, while all-cause death (HR=1.21, 95%CI 0.48-3.00, P=0.69) and stroke rate (HR=2.31, 95%CI 0.82-6.47, P=0.112) were similar between 2 groups. 2-year outcome showed CABG was associated with higher stroke rate (HR=2.20, 95%CI 1.06-4.55, P=0.034) and lower MI (HR=0.19, 95%CI 0.06-0.59, P=0.004) and repeat revascularization rate (HR=0.22, 95%CI 0.13-0.37, P<0.001), and lower MACCE rate (HR=0.49, 95%CI 0.36-0.68, P<0.001). Compared to MT group, 2-year all-cause death (HR=0.22, 95%CI 0.12-0.42, P<0.001) and MACCE rate (HR=0.63, 95%CI 0.47-0.83, P=0.001) were lower in PCI group, while 2-year all-cause death (HR=0.21, 95%CI 0.13-0.37, P<0.001), MACCE (HR=0.31, 95%CI 0.23-0.42, P<0.001), MI (HR=0.19, 95%CI 0.06-0.60, P=0.004) and repeat revascularization rate (HR=0.24, 95%CI 0.13-0.41, P<0.001) were lower in CABG group. Results of multivariate Cox regression analysis after PSM were consistent with above results.
Conclusion:For SCAD patients with TVD, CABG shows better effectiveness by reducing MI and revascularization risk as compared to PCI, even though stroke risk is somehow higher in CABG patients. Patients received MT alone are associated with worse outcomes than those undergoing revascularization strategies.
