BACKGROUND AND AIMS The long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease remain debated. METHODS The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry was used to analyse 57 097 revascularized patients with NSTEMI with multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality; the secondary endpoints included myocardial infarction (MI), stroke, new revascularization, and heart failure. Multilevel logistic regression with follow-up time as a log-transformed offset variable and double-robust adjustment with the instrumental variable method were applied to control for known and unknown confounders. RESULTS Percutaneous coronary intervention was the primary therapy in 42 190 (73.9%) patients, while 14 907 (26.1%) received CABG. Percutaneous coronary intervention patients were generally older with more prior cardiovascular events, whereas CABG patients had higher incidences of diabetes, hypertension, left main and three-vessel disease, and reduced ejection fraction. Over a median follow-up of 7.1 years, PCI was associated with higher risks of death [adjusted odds ratio (aOR) 1.67; 95% confidence interval (CI) 1.54-1.81] and MI (aOR 1.51; 95% CI 1.41-1.62) but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95% CI 2.57-3.51), while heart failure risk was 15% higher (aOR 1.15; 95% CI 1.07-1.25). Coronary artery bypass grafting provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though this benefit diminished over shorter time horizons. CONCLUSIONS Coronary artery bypass grafting is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.

中文翻译：

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非 ST 段抬高型心肌梗死伴多支血管疾病的经皮血运重建与手术血运重建：SWEDEHEART 登记处。


背景和目的 经皮冠状动脉介入治疗 （PCI） 与冠状动脉旁路移植术 （CABG） 在非 ST 段抬高型心肌梗死 （NSTEMI） 和多支血管疾病患者中的长期结局仍存在争议。方法 根据推荐疗法登记处评估的瑞典增强和发展心脏病循证护理网络系统用于分析 2005 年 1 月至 2022 年 6 月瑞典 57 097 例患有多支血管疾病的 NSTEMI 血运重建患者。主要终点是全因死亡率，包括住院和长期死亡率;次要终点包括心肌梗死 （MI） 、卒中、新血运重建和心力衰竭。采用以随访时间为对数转换偏移变量的多水平 logistic 回归和用工具变量法进行双重稳健调整来控制已知和未知的混杂因素。结果 经皮冠状动脉介入治疗是 42 190 例 （73.9%） 患者的主要治疗，而 14 907 例 （26.1%） 接受 CABG。经皮冠状动脉介入治疗患者年龄较大，既往心血管事件较多，而 CABG 患者糖尿病、高血压、左主干和三支血管疾病的发生率较高，射血分数降低。在中位随访 7.1 年中，PCI 与较高的死亡风险相关 [校正比值比 （aOR） 1.67;95% 置信区间 （CI） 1.54-1.81] 和 MI （aOR 1.51;95% CI 1.41-1.62），但在卒中方面没有显著差异。重复血运重建发生 PCI 的可能性高出 3 倍 （aOR 3.01;95% CI 2.57-3.51），而心力衰竭风险高出 15% （aOR 1.15;95% CI 1.07-1.25）。 冠状动脉旁路移植术在 15 年内提供了更长的生存期，尤其是 70 岁以下患有左主干疾病或左心室功能障碍的患者，尽管这种益处在较短的时间范围内减弱。结论 冠状动脉旁路移植术与 NSTEMI 患者的死亡、心肌梗死、重复血运重建和心力衰竭风险降低相关，尤其是在高危亚组中。然而，它的生存益处会随着预期寿命的缩短而减弱。