老年复杂冠状动脉疾病患者血运重建后的 10 年随访。
10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease.
机构信息
Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.
Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
出版信息
J Am Coll Cardiol. 2021 Jun 8;77(22):2761-2773. doi: 10.1016/j.jacc.2021.04.016.
BACKGROUND
The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear.
OBJECTIVES
The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD).
METHODS
In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models.
RESULTS
Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; p = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; p = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients.
CONCLUSIONS
Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050) (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
背景
对于患有复杂冠状动脉疾病的老年人，最佳血运重建策略仍不清楚。
目的
本研究旨在探讨经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）后 10 年全因死亡率、预期寿命、5 年主要不良心脑血管事件（MACCE）和 5 年生活质量（QOL）在 3 血管疾病（3VD）和/或左主干疾病（LMD）的老年（>70 岁）个体中的差异。
方法
在 SYNTAX 扩展生存研究的预先设定的年龄分析中，通过 Kaplan-Meier 估计和 Cox 比例风险模型比较老年和非老年患者的 10 年全因死亡和 5 年 MACCE。通过 10 年内受限平均生存时间估计预期寿命，通过西雅图心绞痛问卷评估 5 年内的 QOL 状况，采用线性混合效应模型。
结果
在 1800 名随机患者中，575 名（31.9%）为老年人。在老年患者中，PCI 和 CABG 之间 10 年死亡率无显著差异（44.1% vs. 41.1%；风险比 [HR]：1.08；95%置信区间 [CI]：0.84 至 1.40）和非老年患者（21.1% vs. 16.6%；HR：1.30；95% CI：1.00 至 1.69；p=0.332）。在老年患者中，PCI 和 CABG 之间 5 年 MACCE 无显著差异（39.4% vs. 35.1%；HR：1.18；95% CI：0.90 至 1.56），而非老年患者中 PCI 显著高于 CABG（36.3% vs. 23.0%；HR：1.69；95% CI：1.36 至 2.10；p=0.043）。老年患者中，PCI 和 CABG 之间的预期寿命（平均差异：0.2 年，CABG 有利；95% CI：-0.4 至 0.7）和 5 年 QOL 状况无显著差异。
结论
患有 3VD 和/或 LMD 的老年患者，无论血运重建方式如何，10 年全因死亡率、预期寿命、5 年 MACCE 和 5 年 QOL 状况相当。（PCI 联合 TAXUS 与心脏手术的协同作用：SYNTAX 扩展生存 [SYNTAXES]；NCT03417050）（SYNTAX 研究：TAXUS 药物洗脱支架与冠状动脉旁路移植术治疗狭窄动脉 [SYNTAX]；NCT00114972）。
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