■我们旨在研究经皮冠状动脉介入治疗与药物洗脱支架和冠状动脉旁路移植术在接受透析患者中的比较效果。
■这是一项回顾性观察性队列研究。
■这项基于人群的研究在台湾国民健康保险研究数据库中确定了2009年1月1日至2015年12月31日因冠状动脉血运重建而住院的透析患者。
■与冠状动脉旁路移植术相比,患者接受药物洗脱支架经皮冠状动脉介入治疗。
■研究结果是全因死亡率,住院死亡率,并重复血运重建。
■使用倾向评分来匹配患者。建立Cox比例风险模型和逻辑回归模型,以检查血运重建策略与死亡率之间的关联。拟合区间Cox模型来估计不同时期的时变风险。
■共分析了1,840名接受透析的倾向评分匹配的患者。冠状动脉旁路移植术与更高的院内死亡率相关(冠状动脉旁路移植术与经皮冠状动脉介入治疗药物洗脱支架;粗死亡率12.5%vs3.3%;校正OR,5.22;95%CI,3.42-7.97;P<0.001)和更长的住院时间(中位数[IQR],20[14-30]天vs3[2-8]天;P<0.001)。放电后,重复血运重建,急性冠脉综合征,在经皮冠状动脉介入治疗和药物洗脱支架组中,重复住院的发生率更高。重要的是,中位随访时间为2.8年,冠状动脉旁路移植术与全因总死亡率的高风险显著相关(调整后的HR,1.19;95%CI,1.05-1.35;P=0.006)在多变量Cox比例风险模型中。敏感性和亚组分析得出一致的结果。
■这是一项主要针对亚洲种族的观察性研究。
■在接受透析的患者中,使用药物洗脱支架的经皮冠状动脉介入治疗可能比冠状动脉旁路移植术具有更好的生存率。未来的研究有必要证实这一发现。
尽管冠状动脉旁路移植术在普通人群中的长期生存率优于经皮冠状动脉介入治疗药物洗脱支架,接受透析的患者可能过于虚弱,无法耐受冠状动脉旁路移植术增加的围手术期死亡风险.在这项针对台湾接受透析的全国患者队列的回顾性研究中,与冠状动脉旁路移植术相比,采用药物洗脱支架的经皮冠状动脉介入治疗与更低的院内死亡率和更好的长期生存率相关.随后的急性冠脉综合征,重复血运重建,在采用药物洗脱支架的经皮冠状动脉介入治疗组中,再次住院的频率更高.这些发现可能表明,经皮冠状动脉介入治疗与药物洗脱支架作为透析患者的安全血运重建策略。
UNASSIGNED: We aimed to
study the comparative effectiveness of percutaneous coronary intervention with drug-eluting stent and coronary artery bypass grafting in patients receiving dialysis.
UNASSIGNED: This was a retrospective observational cohort
study.
UNASSIGNED: This population-based
study identified patients receiving dialysis hospitalized for coronary revascularization between January 1, 2009 and December 31, 2015, in the Taiwan National Health Insurance Research Database.
UNASSIGNED: Patients received percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting.
UNASSIGNED: The
study outcomes were all-cause mortality, in-hospital mortality, and repeat revascularization.
UNASSIGNED: Propensity scores were used to match patients. Cox proportional hazards models and logistic regression models were constructed to examine associations between revascularization strategies and mortality. Interval Cox models were fitted to estimate time-varying hazards during different periods.
UNASSIGNED: A total of 1,840 propensity score-matched patients receiving dialysis were analyzed. Coronary artery bypass grafting was associated with higher in-hospital mortality (coronary artery bypass grafting vs percutaneous coronary intervention with drug-eluting stent; crude mortality rate 12.5% vs 3.3%; adjusted OR, 5.22; 95% CI, 3.42-7.97; P < 0.001) and longer hospitalization duration (median [IQR], 20 [14-30] days vs 3 [2-8] days; P < 0.001). After discharge, repeat revascularization, acute coronary syndrome, and repeat hospitalization all occurred more frequently in the percutaneous coronary intervention with drug-eluting stent group. Importantly, with a median follow-up of 2.8 years, coronary artery bypass grafting was significantly associated with a higher risk of all-cause overall mortality (adjusted HR, 1.19; 95% CI, 1.05-1.35; P = 0.006) in the multivariable Cox proportional hazard model. Sensitivity and subgroup analyses yielded consistent results.
UNASSIGNED: This was an observational
study with mainly Asian ethnicity.
UNASSIGNED: Percutaneous coronary intervention with drug-eluting stent may be associated with better survival than coronary artery bypass grafting in patients receiving dialysis. Future studies are warranted to confirm this finding.
Although coronary artery bypass grafting offers better long-term survival in the general population than percutaneous coronary intervention with drug-eluting stent, patients receiving dialysis may be too frail to tolerate the increased perioperative mortality risk of coronary artery bypass grafting. In this retrospective study in a national cohort of patients receiving dialysis from Taiwan, percutaneous coronary intervention with drug-eluting stent is associated with lower in-hospital mortality and better long-term survival when compared with coronary artery bypass grafting. Subsequent acute coronary syndrome, repeat revascularization, and rehospitalization were noted more frequently in the percutaneous coronary intervention with drug-eluting stent group. These findings may suggest percutaneous coronary intervention with drug-eluting stent as a safe revascularization strategy for patients receiving dialysis.