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Assessing the association of appropriateness of coronary revascularization and 1-year clinical outcomes for patients with stable coronary artery disease in China

摘要Background:The Chinese appropriate use criteria (AUC) for coronary revascularization was released in 2016 to improve the use of coronary revascularization.This study aimed to evaluate the association between the appropriateness of coronary revascularization based on the Chinese AUC and 1-year outcomes in stable coronary artery disease (CAD) patients.Methods:We conducted a prospective,multi-center cohort study of stable CAD patients with coronary lesion stenosis ≥50%.After the classification of appropriateness based on Chinese AUC,patients were categorized into the coronary revascularization group or the medical therapy group based on treatment received.The primary outcome was a composite of death,myocardial infarction,stroke,repeated revascularization,and ischemic symptoms with hospital admission.Results:From August 2016 to August 2017,6085 patients were consecutively enrolled.Coronary revascularization was associated with a lower adjusted hazard of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs;hazard ratio [HR]:0.62;95% confidence interval [CI]:0.45-0.86;P =0.004) than medical therapy in patients with appropriate indications (n =1617).No significant benefit in 1-year MACCEs was found after revascularization compared to after medical therapy in patients with uncertain indications (n =2658,HR:0.81;95% CI:0.52-1.25;P =0.338) and inappropriate indications (n =1810,HR:0.80;95% CI:0.51-1.23;P=0.308).Contusions:In patients with appropriate indications according to Chinese AUC,coronary revascularization was associated with significantly lower risk of MACCEs at 1 year.No benefit was found in coronary revascularization in patients with inappropriate indications.Our findings provide evidence for using Chinese AUC to guide clinical decision-making.

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作者单位 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China [1] National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China;Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037, China [2] Department of Information Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037, China [3] National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China;Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China [4] Department of Cardiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China [5] Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China [6] Department of Cardiology, Peking University People's Hospital, Beijing 100044, China [7]
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DOI 10.1097/CM9.0000000000000592
发布时间 2020-04-14
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