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Comparison of Long-term Outcomes in Patients with Premature triple-vessel coronary disease Undergoing Three Different Treatment Strategies： A Prospective Cohort Study

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Chinese Medical Journal 2018年第1期131卷 1-9页

作者： Jing-Jing Xu Yin Zhang Lin Jiang Jian Tian Lei Song Zhan Gao Xin-Xing Feng Xue-Yan Zhao Yan-Yan Zhao Dong Wang Kai Sun Lian-Jun Xu Ru Liu Run-Lin Gao Bo Xu Lei Song Jin-Qing Yuan Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China Department of Endocrinology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China Medical Research and Biometrics Center Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China Department of State Key Laboratory of Cardiovascular disease State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China Department of Hypertension Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Science and Peking Union Medical College Beijing 100037 China

Background： Patients with premature triple-vessel disease （PTVD） have a higher risk of recurrent coronary events and repeat revascularization： however, the long-term outcome of coronary artery bypass grafting （CABG）, percutaneous coronary intervention （PCI）, and medical therapy （MT） alone for PTVD patients is controversial. The aim of this study is to evaluate the long-term outcome of PTVD patients among these three treatment strategies, to find out the most appropriate treatment methods lbr these patients. Methods： One thousand seven hundred and ninety-two patients with PTVD （age： men 〈50 years and women _〈60 years） were enrolled between 2004 and 2011. The primary end point was all-cause death. The secondary end points were cardiac death, myocardial infarction, stroke, or repeat revascularization. Results： PCI, CABG, and MT alone were performed in 933 （52.1%）, 459 （25.6%）, and 400 （22.3%） patients. Both PCI and CABG were associated with lower all-cause death （4.6% vs. 4.1% vs. 15.5%, respectively, P 〈 0.01） and cardiac death （2.8% vs. 2.0% vs. 9.8%, respectively, P 〈 0.01 ） versus MT alone. The rate of repeat revascularization in the CABG group was significantly lower than those in the PCI and MT groups. After adjusting for baseline factors, PCI and CABG were still associated with similar lower risk of all-cause death and cardiac death versus MT alone （all-cause death： hazard ratio [HR]： 0.35, 95% confidence interval [CI]： 0.23-0.53, P 〈 0.01 and HR： 0.35, 95% CI： 0.18-0.70, P= 0.003, respectively, and cardiac death： HR： 0.32, 95% CI： 0.19-0.54, P〈 0.01 and HR： 0.36, 95% CI：0.14-0.93, P = 0.03, respectively）. Conclusions： PCI and CABG provided equal long-term benefits for all-cause death and cardiac death for PTVD patients. Patients undergoing MT alone had the worst long-term clinical outcomes.

关键词： coronary Artery Bypass Grafting Medical Therapy: Percutaneous coronary Intervention: Premature coronary Heart disease triple-vessel coronary disease

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