Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome: a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry

被引:1
|
作者
von Koch, Sacharias [1 ]
Koul, Sasha [1 ]
Grimfjard, Per [2 ]
Andersson, Jonas [3 ]
Jernberg, Tomas [4 ]
Omerovic, Elmir [5 ]
Frobert, Ole [6 ,7 ]
Erlinge, David [1 ]
A Mohammad, Moman [1 ]
机构
[1] Lund Univ, Skane Univ Hosp, Dept Cardiol, Clin Sci, Lund, Sweden
[2] Vasteras Hosp, Dept Internal Med, Vasteras, Sweden
[3] Umea Univ Hosp, Dept Publ Hlth & Clin Med, Umea, Sweden
[4] Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden
[5] Sahlgrens Univ Hosp, Dept Cardiol, Gothenburg, Sweden
[6] Orebro Univ, Fac Hlth, Dept Cardiol, Orebro, Sweden
[7] Aarhus Univ Hlth, Dept Clin Med, Aarhus, Denmark
关键词
Percutaneous Coronary Intervention; Cardiovascular Diseases; Angina Pectoris; Atherosclerosis; Pharmacology; Clinical; COMPOSITE END-POINTS; MYOCARDIAL-INFARCTION; WIN RATIO; METAANALYSIS; SURVIVAL; SURGERY; TRIALS;
D O I
10.1136/heartjnl-2024-324307
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:1307 / 1315
页数:9
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