Long-term outcome of percutaneous or surgical revascula-rization with and without prior stroke in patients with three-vessel disease
Na XU
Ce ZHANG
Lin JIANG
Jing-Jing XU
Ru LIU
Ying SONG
Xue-Yan ZHAO
Lian-Jun XU
Run-Lin GAO
Bo XU
Jin-Qing YUAN
Lei SONG
Center for Coronary Heart Disease,National Clinical Research Center for Cardiovascular Diseases,National Center for Cardiovascular Diseases,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,China
摘要：OBJECTIVE To determine whether high-risk patients with three-vessel disease (TVD) with and without prior stroke preferen-tially benefit from three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT)].METHODS A total of 8943 patients with TVD were included in the study. Patients enrolled were stratified into two categories according to the presence or absence of prior stroke history. The primary endpoint was all-cause death. Secondary endpoints in-cluded stroke and major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction (MI), unplanned revascularization and stroke. RESULTS Prior stroke was present in 888 patients (9.9％). These patients were older and had higher rates of comorbidities. Du-ring a median follow-up of 7.5 years, patients with prior stroke were strongly associated with increased risks of all-cause death, cardiac death, stroke and MACCE, even after adjusting for confounding variables and results been consistent across either treat-ment subgroup (PCI, CABG and MT) (all adjusted P < 0.01). Notably, there was a significant interaction between prior stroke his-tory and treatment strategies. Revascularization strategy (PCI or CABG) was associated with a lower incidence of all-cause death and MACCE compared with MT alone, and favorable rates of MACCE, MI and unplanned revascularization in the CABG group compared with the PCI group, but with similar rate of all-cause death regardless of prior stroke history. The prevalence of stroke was significantly higher after CABG when compared with PCI or MT in no prior stroke patients [hazard ratio (HR) = 1.429, 95％ CI:1.132–1.805 for CABG vs. MT; HR = 1.703, 95％ CI: 1.371–2.116 for CABG vs. PCI]. CONCLUSIONS Patients with TVD and prior stroke have poor clinical outcomes. It is essential to balance benefit and risk when determining the optimal treatment strategy for TVD with and without prior stroke.
机标关键词：percutaneousstrokediseaselong-termoutcomepatientspriorrevascula
论文发表日期：2022-08-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：11( 583-593 )