METHODS: We analysed a nationwide, comprehensive, and universal administrative database of consecutive patients for the first time admitted in hospital for HF, without a history of CAD, who survived 30 days after index admission from 2015 to 2019 in Italy. Enrolled patients were classified into subjects who did not undergo CVG; those who underwent CVG without coronary revascularization; those who underwent percutaneous coronary intervention (PCI); and those who underwent coronary artery bypass grafting (CABG).
RESULTS: During the study period, 342,090 patients were hospitalized for the first time due to HF and survived 30 days after admission, in Italy. Among them, 30,806 (9.0%) patients underwent CVG without undergoing coronary revascularization, 5855 (1.7%) underwent PCI and 1594 (0.5%) underwent CABG. After adjusting for age, gender and comorbidity, the hazard ratio (HR) for 1-year all-cause mortality in patients undergoing CVG vs no CVG were 0.56 (p < 0.0001), 0.66 (p < 0.0001) and 0.83 (p = 0.020) for CVG, PCI and CABG patients, respectively. When considering the re-hospitalization for HF as the outcome, using death as a competing risk, after multiple corrections, CVG (HR = 0.80; p < 0.0001) and CABG (HR = 0.73; p < 0.0002) were protective versus No CVG, but not PCI (HR = 1.02; p = 0.642).
CONCLUSIONS: This study provides evidence that CVG and coronary revascularization may be beneficial for patients with de novo HF.
方法:我们分析了全国范围内的,全面,以及首次住院的连续患者的通用管理数据库,没有CAD的历史,从2015年到2019年,他在意大利的指数录取后存活了30天。纳入的患者分为未接受CVG的受试者;接受CVG但未进行冠状动脉血运重建的受试者;接受经皮冠状动脉介入治疗(PCI)的受试者;以及接受冠状动脉旁路移植术(CABG)的受试者。
结果:在研究期间,342,090例患者因HF首次住院,并在入院后30天存活,在意大利。其中,30,806例(9.0%)患者接受了CVG而未接受冠状动脉血运重建,5855(1.7%)行PCI,1594(0.5%)行CABG。在调整了年龄之后,性别和合并症,CVG与无CVG患者1年全因死亡率的风险比(HR)为0.56(p<0.0001),CVG为0.66(p<0.0001)和0.83(p=0.020),PCI和CABG患者,分别。当考虑心力衰竭的再住院作为结果时,将死亡作为一种竞争风险,经过多次修正,与无CVG相比,CVG(HR=0.80;p<0.0001)和CABG(HR=0.73;p<0.0002)具有保护性,但不是PCI(HR=1.02;p=0.642)。
结论:本研究提供了CVG和冠状动脉血运重建术可能对新发HF患者有益的证据。