Percutaneous coronary intervention vs. medical therapy in patients on dialysis with coronary artery disease in China

被引：0

作者：

Xie Enmin ^{[1
,2
]}

Wu Yaxin ^{[3
]}

Ye Zixiang ^{[4
]}

He Yong ^{[5
]}

Zeng Hesong ^{[6
]}

Luo Jianfang ^{[7
]}

Chen Mulei ^{[8
]}

Pang Wenyue ^{[9
]}

Xu Yanmin ^{[10
]}

Gao Chuanyu ^{[3
]}

Guo Xiaogang ^{[11
]}

Cai Lin ^{[12
]}

Ji Qingwei ^{[13
]}

Yang Yining ^{[14
]}

Wu Di ^{[15
]}

Yuan Yiqiang ^{[16
]}

Wan Jing ^{[17
]}

Ma Yuliang ^{[18
]}

Zhang Jun ^{[19
]}

Du Zhimin ^{[20
]}

Yang Qing ^{[21
]}

Cheng Jinsong ^{[22
]}

Ding Chunhua ^{[23
]}

Ma Xiang ^{[24
]}

Yin Chunlin ^{[25
]}

Fan Zeyuan ^{[26
]}

Tang Qiang ^{[27
]}

Li Yue ^{[28
]}

Sun Lihua ^{[29
]}

Lu Chengzhi ^{[30
]}

Chi Jufang ^{[31
]}

Yao Zhuhua ^{[32
]}

Gao Yanxiang ^{[1
]}

Yu Changan ^{[1
]}

Ren Jingyi ^{[1
]}

Zheng Jingang ^{[1
,2
]}

机构：

[1] Department of Cardiology, China-Japan Friendship Hospital, Beijing, China

[2] Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

[3] Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China

[4] Department of Cardiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China

[5] Department of Cardiology, West China Hospital, Chengdu, Sichuan, China

[6] Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

[7] Department of Cardiology, Guangdong Provincial People’s Hospital, Guangzhou, Guangdong, China

[8] Department of Cardiology, Beijing Chaoyang Hospital, Beijing, China

[9] Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China

[10] Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China

[11] Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

[12] Department of Cardiology, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China

[13] Department of Cardiology, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China

[14] Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China

[15] Department of Cardiology, Emergency General Hospital, Beijing, China

[16] Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, Henan, China

[17] Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China

[18] Department of Cardiology, Peking University People’s Hospital, Beijing, China

[19] Department of Cardiology, Cangzhou Central Hospital of Tianjin Medical University, Cangzhou, Hebei, China

[20] Department of Cardiology, Dongguan Tungwah Hospital, Dongguan, Guangdong, China

[21] Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China

[22] Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang, China

[23] Department of Cardiology, Aerospace Center Hospital, Beijing, China

[24] Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China

[25] Department of Cardiology, Xuanwu Hospital, Beijing, China

[26] Department of Cardiology, Civil Aviation General Hospital, Beijing, China

[27] Department of Cardiology, Peking University Shougang Hospital, Beijing, China

[28] Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China

[29] Department of Cardiology, Fifth Affiliated Hospital of Xinjiang Medical University, Xinjiang, China

[30] Department of Cardiology, First Central Hospital of Tianjin, Tianjin, China

[31] Department of Cardiology, Shaoxing People’s Hospital, Shaoxing, Zhejiang, China

[32] Department of Cardiology, Tianjin Union Medicine Center, Tianjin, China

来源：

中华医学杂志英文版 | 2025年 / 138卷 / 03期

关键词：

Coronary artery disease; Dialysis; End-stage renal disease; Percutaneous coronary intervention; Prognosis;

D O I：

暂无

中图分类号：

R541.4 [冠状动脉（粥样）硬化性心脏病（冠心病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China.Methods: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences.Results: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [n = 278]vs. 43.7% [n = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1%vs. 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses.Conclusion: This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.

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