Implications of left atrial volume index in patients with three-vessel coronary disease:A 6.6-year follow-up cohort studyOA北大核心CSTPCDMEDLINE
Implications of left atrial volume index in patients with three-vessel coronary disease:A 6.6-year follow-up cohort study
Background:Risk assessment and treatment stratification for three-vessel coronary disease(TVD)remain challenging.This study aimed to investigate the prognostic value of left atrial volume index(LAVI)with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score Ⅱ,and its association with the long-term prognosis after three strategies(percutaneous coronary intervention[PCI],coronary artery bypass grafting[CABG],and medical therapy[MT])in patients with TVD. Methods:This study was a post hoc analysis of a large,prospective cohort of patients with TVD in China,that aimed to determine the long-term outcomes after PCI,CABG,or optimal MT alone.A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital.A total of 7818 patients with available baseline LAVI data were included in the study.Baseline,procedural,and follow-up data were collected.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE),which was a composite of all-cause death,myocardial infarction(MI),and stroke.Secondary endpoints included all-cause death,cardiac death,MI,revascularization,and stroke.Long-term outcomes were evaluated among LAVI quartile groups. Results:During a median follow-up of 6.6 years,a higher LAVI was strongly associated with increased risk of MACCE(Q3:hazard ratio[HR]1.20,95%confidence interval[CI]1.06-1.37,P=0.005;Q4:HR 1.85,95%CI 1.64-2.09,P<0.001),all-cause death(Q3:HR 1.41,95%CI 1.17-1.69,P<0.001;Q4:HR 2.54,95%CI 2.16-3.00,P<0.001),and cardiac death(Q3:HR 1.81,95%CI 1.39-2.37,P<0.001;Q4:HR 3.47,95%CI 2.71-4.43,P<0.001).Moreover,LAVI significantly improved discrimination and reclassification of the SYNTAX score Ⅱ.Notably,there was a significant interaction between LAVI quartiles and treatment strategies for MACCE.CABG was associated with lower risk of MACCE than MT alone,regardless of LAVI quartiles.Among patients in the fourth quartile,PCI was associated with significantly increased risk of cardiac death compared with CABG(HR:5.25,95%CI:1.97-14.03,P=0.001). Conclusions:LAVI is a potential index for risk stratification and therapeutic decision-making in patients with three-vessel coronary disease.CABG is associated with improved long-term outcomes compared with MT alone,regardless of LAVI quartiles.When LAVI is severely elevated,PCI is associated with higher risk of cardiac death than CABG.
Ru Liu;Ou Xu;Chongjian Li;Runlin Gao;Rutai Hui;Wei Zhao;Jinqing Yuan;Lei Song;Ce Zhang;Lin Jiang;Jian Tian;Lianjun Xu;Xinxing Feng;Linyuan Wan;Xueyan Zhao
Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China||Department of Respiratory and Pulmonary Vascular Disease,Fuwai Yunnan Cardiovascular Hospital,Kunming,Yunnan 650102,ChinaDepartment of Respiratory and Pulmonary Vascular Disease,Fuwai Yunnan Cardiovascular Hospital,Kunming,Yunnan 650102,ChinaDepartment of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,ChinaInformation Center,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,ChinaDepartment of Endocrinology,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,ChinaDepartment of Echocardiography,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China
Three-vessel coronary diseaseLeft atrial volume indexCoronary artery bypass graftingPercutaneous coronary in-terventionMyocardial ischemiaPrognosis
《中华医学杂志(英文版)》 2024 (004)
441-449 / 9
This study is supported by National Program on Key Basic Research Project(973 Program,No.2010CB732601);National High-Tech Research and Development Program of China(863 Program,No.2015AA020407);Beijing Municipal Science & Technology Commission(No.Z191100006619106);National Natural Science Foundation of China(Nos.81470380 and 81770365);National Key Research and Development Program of the Ministry of Science and Technology of China during the"13th Five-Year Plan"(No.2016YFC1301301);National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences(No.NCRC2020013);Key Project of Yunnan National Regional Medical Center for Cardiovascular Diseases(No.202002AA310100-14);and Beijing United Heart Foundation(No.BJUHFCSOARF201901-19).
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