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

作　　者：Enmin Xie Yaxin Wu Zixiang Ye Yong He Hesong Zeng Jianfang Luo Mulei Chen Wenyue Pang Yanmin Xu Chuanyu Gao Xiaogang Guo Lin Cai Qingwei Ji Yining Yang Di Wu Yiqiang Yuan Jing Wan Yuliang Ma Jun Zhang Zhimin Du Qing Yang Jinsong Cheng Chunhua Ding Xiang Ma Chunlin Yin Zeyuan Fan Qiang Tang Yue Li Lihua Sun Chengzhi Lu Jufang Chi Zhuhua Yao Yanxiang Gao Changan Yu Jingyi Ren Jingang Zheng 

机构地区：[1]Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China [2]Department of Cardiology,China-Japan Friendship Hospital(Institute of Clinical Medical Sciences),Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100029,China [3]Department of Cardiology,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 450003,China [4]Department of Cardiology,Peking University China-Japan Friendship School of Clinical Medicine,Beijing 100029,China [5]Department of Cardiology,West China Hospital,Chengdu,Sichuan 610041,China [6]Department of Cardiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China [7]Department of Cardiology,Guangdong Provincial People’s Hospital,Guangzhou,Guangdong 510080,China [8]Department of Cardiology,Beijing Chaoyang Hospital,Beijing 100020,China [9]Department of Cardiology,Shengjing Hospital of China Medical University,Shenyang,Liaoning 117004,China [10]Department of Cardiology,Second Hospital of Tianjin Medical University,Tianjin 300192,China [11]Department of Cardiology,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang 310003,China [12]Department of Cardiology,The Third People’s Hospital of Chengdu,Chengdu,Sichuan 610014,China [13]Department of Cardiology,The People’s Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi 530021,China [14]Department of Cardiology,People’s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang 830001,China [15]Department of Cardiology,Emergency General Hospital,Beijing 100028,China [16]Department of Cardiology,Henan Provincial Chest Hospital,Zhengzhou,Henan 450003,China [17]Department of Cardiology,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430071,China [18]Department of Cardiology,Peking University People’s Hospital,Beijing 100044,China [19]Department of Cardiology,Cangzhou Central Hospital of Tianjin Medical University,Cangzhou,Hebei 061001,China [20]Department of Cardiology,Dongguan Tungwah Hospital,

出　　处：《Chinese Medical Journal》2025年第3期301-310,共10页中华医学杂志(英文版)

基　　金：National High Level Hospital Clinical Research Funding(No.2024-NHLHCRF-YS-01);Capital’s Founds for Health Improvement and Research(No.2022-1-4062);Beijing Research Ward Construction Clinical Research Project(No.2022-YJXBF-04-03);Science Foundation of China-Japan Friendship Hospital(No.2020-HX-40);National Natural Science Foundation of China(No.82270352);National High Level Hospital Clinical Research Funding(No.2024-NHLHCRF-JBGS-WZ-06);Chinese Society of Cardiology’s Foundation(No.CSCF2021B02);National Key Clinical Specialty Construction Project(No.2020-QTL-009)

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 s

关 键 词：Coronary artery disease DIALYSIS End-stage renal disease Percutaneous coronary intervention PROGNOSIS 

分 类 号：R54[医药卫生—心血管疾病]