The Long-term(>7Years) Followling-up Study And Analysis Of Influencing Factors In Coronary Heart Disease Patients After Revascularization

Background and objective:Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are currently the main invasive treatment of coronary heart disease(CHD). There is rarely>7 years follow-up study analysis of influencing factors on patients with left main and multi-vessel coronary artery disease treated with PCI/CABG in China. This essay is aimed to analyze the long-term prognosis of patients with coronary heart disease treated with PCI/CABG and patients treated with PCI but different revascularization extent and to explore the prevention and treatment strategies in China.Method:A total of 721 patients with left main and multi-vessel coronary artery disease who received PCI/CABG for the first time in intervention center from January 2005 to June 2007 were enrolled in this study. According to the report of coronary angiography, their SYNTAX score, residual SYNTAX score and revascularization extent were calculated. Grouping according to different treatment strategies and revascularization extent tertiles. In this study, based on the total population and different treatment strategies, groups were divided. Baseline data, test and examination, coronary angiography, long-term (>7 years)follow-up result (MACCE) and long-term prognostic factors affecting DES subgroup were compared.Results:A sum of 721 cases were followed up by telephone. Among them,587 cases are males (average age 62.21±11.77) and 134 cases are females (average age 64.89±9.39). The male to female ratio was 4.38:1. According to treatment, patients were divided into 2 groups:PCI group treated with DES (n=566,78.5%) and CABG group(n= 155,21.5%). COX regression analysis in total cohort showed that sex (male) (β =0.357, Exp (β)=1.429,95.0% CI:1.004-2.035),history of hypertension βP=0.340, Exp (β)=1.405,95.0% CI:1.060-1.860) and residual SYNTAX score (β=0.20, Exp (β)=1.020,95%CI:1.013～1.027)、reascularization extent(β=0.972, Exp(β)=2.644, 95%CI:1.811～3.861) were the main risk factors of MACCE incidence. One year and 4-5 years after PCI/CABG were key periods with high incidence of MACCE, and we need to strengthen the follow-up and observation of the patient in these two periods. The rate of MACCE in group A and group B were both lower than in group C(33.20% vs 54.39%, P<0.05;41.49% vs 54.39%,P<0.05);The rate of non-TVR was lower in group A than in group C (13.69% vs 20.5%,P<0.05);From group A to group C, residual SYNTAX scores were significantly increased (0,10,30, P<0.001).By comparing PCI group and CABG group, we found that patient in CABG group has more complex coronary artery disease but higher revascularization extent than PCI group(SYNTAX score:41.23±15.39 vs 52.12 ± 16.55, P<0.001;residual SYNTAX score,10 vs 0, P<0.001); the rate of MACCE, revascularization, angina recurrence and non-TVR were higher in PCI group (48.9% vs 21.3%, P<0.001, TVR:21.6% vs 3.2%, P<0.001, non-TVR:18.7% vs 6.5%, P=0.002, Re-Angina:35% vs 19.4%, P<0.001); there was no statistical difference of all-cause death/nonfatal MI/nonfatal stroke(10.2% vs 11.6, respectively %, P=0.624; 3.0% vs 1.9%, P=0.659; 0.5% vs 1.3%, P=0.996). For patient with complex coronary artery disease, CABG was better than PCI, but PCI was safe and feasible. PCI (DES) subgroup analyzes showed:sex(male) (β=0.53,Exp (β)=1.698,95% CI:1.196～2.411), history of hypertension (β=0.33, Exp (β)= 1.39,95% CI:1.053～1.835), SYNTAX score (β=0.008, Exp (β)=1.008,95% CI: 1.000～1.015) were the major risk factors affecting the long-term prognosis of this group of patient. COX regression analysis in total PCI group showed that sex (male) β=0.542, Exp (p),95%CI:1.212-2.438), history of hypertension (β=0.296, Exp (β) =1.345,95%CI:1.018-1.776),and residual SYNTAX score (β=0.011, Exp (β) =1.011,95%CI:1.003-1.018) were the main risk factors of long-term MACCE incidence. Revascularization extent(RE) was the main risk factors of long-term MACCE incidence, too (β=0.186, Exp (p)=1.205,95% CI:1.040-1.395).The rate of MACCE was significantly lower in group A lthan in group C1 (42.0% vs 56.1%, P=0.0239). From group A1 to group C1,SYNTAX score and residual SYNTAX score were significantly increased (bSS:37.59±17.03,41.68±14.94,47.09±15.39, P< 0.05;rSS:0,13,33, P<0.05)Conclusion:1.Sex (male), history of hypertension were not only a risk factor for CHD, but also the main risk factors affecting long-term prognosis. SYNTAX score, residual SYNTAX score and revascularization extent(RE) were the major risk factors affecting the long-term prognosis.2.One year and 4-5 years after PCI/CABG were key periods with high incidence of MACCE, and we need to strengthen the follow-up of the patients with left main and multi-vessel coronary artery disease in these two periods.3.For patient with complex coronary artery disease, PCI was safe and feasible, but CABG still has its superiority.4.SYNTAX score may act as an effective tool for evaluating the complexity and long-term (>7years) prognosis of patients with complex coronary artery disease after PCI.5.Revascularization extent(RE) and residual SYNTAX score may act as an effective tool for evaluating the coronary revascularization and long-term prognosis of patients undergoing PCI or CABG.