摘要
目的 对比经皮冠状动脉介入术（PCI）和冠状动脉旁路移植术（CABG）治疗无保护左主干病变的长期预后.方法 入选2003年1月至2009年7月北京安贞医院行PCI或CABG治疗的无保护左主干病变患者922例（465例行PCI置入药物洗脱支架,457例行CABG）,研究终点包括全因死亡、心原性死亡、心肌梗死、再次血运重建、卒中、心原性死亡死亡/心肌梗死/卒中联合硬终点以及主要不良心脑血管事件（MACCE,包括心原性死亡、非致命性心肌梗死、卒中及再次血运重建的联合终点）.Cox比例风险模型用以计算风险比（HR）及95％CI,进行多因素分析.结果 随访时间7.1（5.3,8.2）年,校正前PCI组和CABG组间不良事件发生率：全因死亡[13.0％ （41/465）比22.1％（72/457）,P=0.027]、卒中[5.8％ （11/465）比18.9％ （46/457）,P＜0.001]、心原性死亡/心肌梗死/卒中[19.9％ （58/465）比30.4％（101/457）,P=0.009]、再次血运重建[32.3％（110/465）比19.2％（58/457）,P＜0.001]的发生率差异有统计学意义;心原性死亡[7.3％ （26/465）比10.1％ （43/457）,P =0.059]、心肌梗死[13.9％ （33/465）比6.7％ （26/457）,P=0.196]、MACCE [42.9％（145/465）比42.5％（142/457）,P=0.122]发生率差异无统计学意义.多因素校正后PCI组MACCE发生率明显高于CABG组（P =0.009）,主要归因于PCI组较CABG显著升高的再次血运重建发生率（P＜0.001）;两组间全因死亡（P=0.112）、心原性死亡（P=0.594）及心原性死亡/心肌梗死/卒中联合硬终点发生率（P =0.309）差异均无统计学意义,CABG组卒中发生率明显高于PCI组（P =0.001）.结论 CABG和PCI治疗无保护左主干病变患者的长期生存率相似,PCI组再次血运重建明显升高,而CABG组卒中发生率明显升高.
Objective To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease （ULMCA） underwent percutaneous coronary intervention （PCI） with drug-eluting stents （DES） and coronary artery bypass grafting （CABG）.Methods Consecutive patients with ULMCA （defined as stenosis≥50％） undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled.The follow-up period extended through August 2013.The end points of the study were death,cardiac death,repeat revascularization,myocardial infarction （MI）,stroke,the composite of cardiac death,MI or stroke and MACCE （major adverse cardiac and cerebrovascular events,the composite of cardiac death,MI,stroke or repeat revascularization）.Results From January 2003 to July 2009,922 ULMCA patients were enrolled in this study （465 PCI patients,and 457 CABG patients）.The median follow-up was 7.1 years （interquartile range 5.3 to 8.2 years）.The crude relative risk was as follows：overall death rate （13.0％ （41/465） vs.22.1％ （72/457）,P =0.009）,stroke rate （5.8％ （11/465） vs.CABG 18.9％ （46/457）,P ＜ 0.001） were significantly lower whereas the rate of repeat revascularization （32.3％ （110/465） vs.CABG 19.2％ （58/457）,P ＜0.001） was significantly higher in PCI group than in CABG group.MI rate was similar between PCI and CABG group （13.9％ （33/465） vs.6.7％ （26/457）,P =0.196）.MACCE rate was also similar between the 2 groups （42.9％ （145/465） vs.42.5％ （142/457）,P =0.122）.After multivariate adjusting,there was no significant difference in rates of death,MI and a composite of serious outcomes （cardiac death,MI,or stroke） between the 2 groups.Rates of MACCE were significantly higher in the PCI group （P =0.009） due to increased rate of repeat revascularization （P ＜0.001）.However,stroke rate was still significantly higher in CABG group （P =0.001） after multivariate adjus
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2015年第5期399-403,共5页
Chinese Journal of Cardiology
基金
首都医学发展科研基金（2009-2074）
