背景:经皮冠状动脉介入治疗(PCI)经常用于慢性冠状动脉综合征(CCS)患者。然而,PCI在CCS中超越症状缓解的作用仍存在争议.这项研究的目的是确定PCI是否与更好的结果相关,与单纯药物治疗(MT)相比。
方法:我们进行了一项回顾性队列研究。使用瑞典冠状动脉造影和血管成形术注册,我们纳入了2010年至2020年在瑞典接受冠状动脉造影的所有CCS患者.根据治疗策略组成两组:PCIMT与单独MT。使用一对一倾向评分(PS)匹配来解决混杂问题。使用匹配胜率分析评估结果,一种根据临床重要性对复合材料成分进行排序的统计方法。主要结果是5年内的净不良临床事件(NACE)。在获胜比率分析中,NACE的组成部分排名如下:(1)全因死亡率,(2)心肌梗死(MI),(3)出血和(4)紧急血运重建。次要结局是NACE的各个组成部分,主要不良心血管事件(MACE)和心血管死亡率。
结果:PS匹配后,两组7220例患者各形成。NACE和MACE的分层结果分析表明,PCI与改善的结果相关(匹配胜率:1.28(95%CI1.20至1.36,p<0.001)和匹配胜率:1.38(95%CI1.29至1.48,p<0.001),分别)。PCI的使用与较高的MI胜率相关(匹配胜率:1.15,95%CI1.04至1.28,p=0.008),紧急血运重建(匹配胜率:1.85,95%CI1.69~2.03,p<0.001)和心血管死亡率(匹配胜率:1.15,95%CI1.00~1.34,p=0.044)。全因死亡率或出血的胜率没有差异。
结论:在这项研究中,它试图使用分层方法评估CCS患者的预后,选择PCI血运重建的患者与单纯MT相比,预后更好.
BACKGROUND: Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone.
METHODS: We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality.
RESULTS: After PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding.
CONCLUSIONS: In this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.