| Aims:To compare effectiveness of percutaneous coronary intervention(PCI),coronary artery bypass grafting(CABG)versus medical therapy(MT)alone for real-world stable coronary artery disease(SCAD)patients with three-vessel disease(TVD)in mainland China.Methods:A total of 8 943 consecutive cases with TVD in a single center from April 2004 to February 2011 were prospectively collected.In this cohort,3 435 cases diagnosed as SCAD were selected in this study.PCI,CABG,MT alone were performed in 1 313(38.2%),1259(36.7%)and 863(25.1%)patients respectively.1-and 2-year clinical outcomes were evaluated between PCI,CABG and MT group.Propensity score matching(PSM)analysis was applied to control baseline differences.Kaplan-Meier curves and multivariable COX regression were used for survival analysis.Results:Many significant differences were found in baseline data between PCI,CABG and MT group.All-cause death rates of 1-and 2-year follow-up of PCI,CABG and MT group were 8/1313,14/1259,29/863(P<0.001)and 14/1313,19/1259,63/863(P<0.001),respectively.After multivariate adjustment,compared to PCI group,1-year MACCE rate(HR:0.51;95%CI:0.33-0.77;P = 0.001)reduced in CABG group,due to the significant decrease of myocardial infarction(MI)rate(HR:0.09;95%CI:0.01-0.76;P=0.027)and repeat revascularization rate(HR:0.21;95%CI:0.10-0.41;P<0.001),while all-cause death and stroke rate showing no significant difference between 2 groups.2-year outcome showed CABG was associated with higher stroke rate(HR:2.20;95%CI:1.06-4.55;P = 0.034)and still lower MI rate(HR:0.19;95%CI:0.06-0.59;P = 0.004)and repeat revascularization rate(HR:0.22;95%CI:0.13-0.37;P<0.0001),thus lowering MACCE rate(HR:0.49;95%CI:0.36-0.68;P<0.001).Compared to MT group respectively,2-year all-cause death and MACCE rate reduced in PCI group,while 2-year all-cause death,MACCE,MI and repeat revascularization rate all reduced in CABG group.Results of multivariate COX regression after PSM were consistent.Conclusion:For SCAD patients with TVD,CABG showed better effectiveness by reducing MI and revascularization risk,even though increasing stroke risk.Patients received MT alone had worse outcomes than those undergoing revascularization.Aims:This paper analyzes the difference of variants carrier frequencies between worse outcomers in three-vessel disease(TVD)CAD patients and normal controllers by single nucleotide polymorphisms(SNP)detection to explan genetic influence associated with prognosis of TVD patients.Methods:A total of 8 943 consecutive cases with TVD in a single center from April 2004 to February 2011 were prospectively collected.Major adverse cardiovascular and cerebrovascular events(MACCE)group was defined as 1-year outcome including all-cause death,acute myocardial infarction,repeat revascularization,readmission and stroke.The same number of normal-control cases were consecutively enrolled from this center.Blood samples of 2 groups were collected and DNA library was built.A total of 34 tag SNPs and hot SNPs in 6 genes including CDKN2B-AS1、ADAMTS7、ABO、ADAMTS13、IL-18、PEC AM1 gene were analyzed by SNPscanTM multi-genotyping kit.The carrier frequency of each SNP was compared between 2 groups by Pearson’s test in dominant,recessive and codominant model.Results:Mutant allele frequency of 9 SNPs in at least one model analysis showed significant difference between 2 groups.They were rs1063192,rs10757274,rs1333042,rs1333049,rs32 1 79 86,rs4977574,rs9632884 on CDKN2B-AS1 gene,rs1055432 on ADAMTS13 gene and rs8176694 on ABO gene.After FDR BH adjustment,carrier frequencies of 7 SNPs were still significant.After multivariable adjustment,G mutant homozygous of rs1063192(GG vs.GA+AA)(OR:0.25;95%CI:0.06-0.10;P = 0.05)and rs9632884(GG vs.GC+CC)(OR:0.24;95%CI:0.09-0.65;P = 0.005)on CDKN2B-AS1 gene were independent protective factors of MACCE in recessive model analysis.Conclusion:In mainland Chinese population,mutant alleles on CDKN2A-AS1,ADAMTS13,ABO gene may be the important genetic basis promoting cardio-cerebrovascular ischemic events. |
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