Prognosis Related to Reperfusion Therapy Post-Acute Coronary Syndrome in Secondary Care: Long-Term Survival Analysis in the ERICO Study

Abstract Background Relationship between reperfusion therapy post-acute coronary syndrome (ACS) and mortality in secondary care is not well-known. Objectives To evaluate the impact of three therapeutic strategies: (1) exclusive medical therapy, (2) percutaneous coronary intervention (PCI) and (3) coronary artery bypass grafting (CABG) on long-term survival of participants in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study. Methods Survival analyses for all-cause, cardiovascular (CVD) and coronary artery disease (CAD) mortality were performed according to three therapeutic strategies (exclusive medical therapy, PCI or CABG). Cox regression models were used to estimate the hazard ratio (HR) with respective 95% confidence interval (95%CI) from 180 days to four years of follow-up after ACS. Models are presented as crude, age-sex adjusted and further adjusted for previous CAD, ACS subtype, smoking, hypertension, dyslipidemia, left ventricular ejection fraction and according to the number of obstructed (≥ 50%) major coronary arteries. Results Among 800 participants, the lowest crude survival rates were detected among individuals who underwent CABG (all-cause and CVD). CABG was correlated to CAD (HR: 2.19 [95% CI: 1.05-4.55]). However, this risk lost significance in the full model. PCI was associated to lower probability of fatal events during four-year follow-up: all-cause [multivariate HR: 0.42 (95% CI: 0.26-0.70)], CVD [HR: 0.39 (95% CI: 0.20-0.73)] and CAD [multivariate HR: 0.24 (95% CI: 0.09-0.63)] compared to those submitted to exclusive medical therapy. Conclusion In the ERICO study, PCI after ACS was associated to better prognosis, particularly CAD survival.

【背景】急性冠状动脉综合征（acute coronary syndrome, ACS）发作后再灌注治疗与二级医疗环境下死亡率的关联尚不明确。
【目的】评估急性冠状动脉综合征登记策略（Strategy of Registry of Acute Coronary Syndrome, ERICO）研究中，三种治疗策略对受试者长期生存的影响：（1）单纯药物治疗；（2）经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）；（3）冠状动脉旁路移植术（coronary artery bypass grafting, CABG）。
【方法】针对全因死亡、心血管（cardiovascular, CVD）死亡及冠状动脉疾病（coronary artery disease, CAD）死亡开展生存分析，分组依据为上述三种治疗策略（单纯药物治疗、PCI或CABG）。采用Cox回归模型估算ACS发病后180天至4年随访期间的风险比（hazard ratio, HR）及对应95%置信区间（95%CI）。模型分为粗模型、年龄-性别校正模型，以及进一步校正既往CAD病史、ACS亚型、吸烟史、高血压、血脂异常、左心室射血分数，并根据阻塞程度≥50%的主要冠状动脉支数进行校正的模型。
【结果】共纳入800名受试者，接受CABG治疗的受试者在全因死亡及CVD死亡维度的粗生存率最低。CABG与CAD死亡风险升高相关（HR: 2.19 [95%CI: 1.05-4.55]），但在完全校正模型中该关联不再具有统计学意义。与单纯药物治疗组相比，PCI组在四年随访期间的致死事件发生概率更低：全因死亡[多变量HR: 0.42 (95%CI: 0.26-0.70)]、CVD死亡[HR: 0.39 (95%CI: 0.20-0.73)]以及CAD死亡[多变量HR: 0.24 (95%CI: 0.09-0.63)]。
【结论】在ERICO研究中，ACS发作后采取PCI治疗与更佳的预后相关，尤其体现在CAD生存结局方面。