英国血管重建术的临床预后正在逐渐改善

英国血管重建术的临床预后正在逐渐改善

Revascularization outcomes improving in the UK

       MedWire 报道：一项大的队列研究显示，冠心病旁路搭桥手术（CABG）和经皮冠脉介入治疗（PCI）在生存率方面相似，尽管在PCI后再次行血管重建术的可能性更大。

       英国莱斯特大学Iain Squire和同事们集中在合并症、人口统计学和种族性的影响方面，研究了在临床常规操作中首次行冠脉血管重建术的临床预后趋势。

       他们调查研究了在1995-1996年间接受CABG或PCI的2,520例患者和与之相对的在2003-2004年间接受CABG或PCI的3,548例患者。

      手术前的合并症1995-1996年和2003-2004年间明显更加流行，伴随更多患者出现伴发的心衰、急性心肌梗死、糖尿病、中风、心律不齐、心绞痛、肝病或肿瘤。

       除此之外，临床预后在这两组间也有改善，PCI患者两年无病生存期的比例从73%增加到83%。

       在调整了合并症和其他混杂变量后，Squire等发现在两年随访期内PCI或CABG患者的全因和心血管死亡率均少于5%，这两种治疗策略间没有区别。

       通过对比，血管重建术比例与CABG相比，PCI要高很多（危害比[HR]=10.56），尽管支架术减弱了重复操作的需求（HR=0.61VS.未支架术）。

       最后，作者表示临床预后并不会因为种族性或社会经济状态而不同，但与男性相比女性有更低的死亡率。

       在《心脏》杂志中，Squire等说这是在英国临床标准操作中最现代的基于人群的冠脉血管重建术预后趋势分析。

       他们记录道：“最重要的是，在实际上比报道的更沉重的并发症负担和明显地总PCI率增加的背景下，在研究阶段PCI患者临床预后明显地改善，为了对那些有效性报道反应。”

       “临床预后在PCI和CABG是相似的，除了远期的血管重建术方面，在PCI后要高10倍。”

Revascularization outcomes improving in the UK

MedWire News: Coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) offer similar survival rates, although repeat revascularization is much more likely after PCI, a large cohort study suggests.

Iain Squire (University of Leicester, UK) and colleagues investigated trends in clinical outcomes after first coronary revascularization in routine clinical practice, with a focus on the influence of comorbidity, demographics, and ethnicity.

They identified 2520 consecutive patients who underwent CABG or PCI in 1995–1996 and compared them with 3548 patients who underwent CABG or PCI in 2003–2004.

Preoperative comorbidities became significantly more prevalent between 1995–1996 and 2003–2004, with more patients reporting concomitant heart failure, acute myocardial infarction, diabetes, stroke, arrhythmia, angina, liver disease, or cancer.

Despite this, clinical outcomes improved between the two time periods, with rates of 2-year event-free survival increasing from 73% to 83% among PCI patients.

After adjusting for comorbidities and other confounding variables, Squire et al found that rates of all-cause and cardiovascular mortality were less than 5% in the 2 years following either PCI or CABG, with no difference between the two strategies.

By contrast, revascularization rates were much higher after index PCI versus CABG (hazard ratio [HR]=10.56), although stenting attenuated the need for repeat procedures (HR=0.61 versus no stenting).

Finally, the authors showed that outcomes did not vary by ethnicity or socioeconomic status but that women had a lower risk for mortality as compared with men (HR=0.73).

Writing in the journal Heart, Squire et al say that this is the most contemporary population-based assessment of outcome trends after coronary revascularization in standard clinical practice in the United Kingdom.

“Most important is the clear improvement during the study period in outcome for patients undergoing PCI on a background of a substantially greater burden of reported comorbidity and a marked increase in overall PCI intervention rate, in response to published reports of their effectiveness,” they write.

“Clinical outcomes were similar after PCI or CABG with the exception of further revascularization, which was 10 times more common after index PCI.”

MedWire is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

来源：www.Incirculation.net