摘要
目的:本研究旨在对比经皮冠状动脉介入术(PCI)和冠状动脉旁路移植术(CABG)治疗高龄(≥65岁)无保护左主干病变(ULMCA)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治疗的高龄(≥65岁)ULMCA患者427例(210例行PCI置入药物洗脱支架,217例行CABG),研究终点包括全因死亡、心肌梗死、再次血运重建、卒中、心源性死亡/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%可信区间(CI),及多因素分析。结果:随访时间7.0(5.2,8.1)年,校正前结果显示,心源性死亡/心肌梗死/卒中联合硬终点发生率CABG组显著高于PCI组(HR=1.544,95%CI:1.003~2.375,P=0.048)。卒中发生率CABG组显著高于PCI组(HR=3.089,95%CI:1.332~7.162,P=0.009)。再次血运重建发生率PCI组显著高于CABG组(HR=0.278,95%CI:0.159~0.486,P<0.001)。全因死亡率两组间差异无统计学意义(HR=1.545,95%CI:0.951~2.510,P=0.079)。非致命性心肌梗死发生率两组间差异无统计学意义(HR=0.619,95%CI:0.314~1.222,P=0.167)。MACCE发生率两组间差异无统计学意义(HR=0.770,95%CI:0.550~1.079;P=0.129)。经Cox多因素分析校正后,CABG组心源性死亡/心肌梗死/卒中联合硬终点发生率仍显著高于PCI组(P=0.048),CABG组卒中发生率显著高于PCI组(P=0.011),PCI组MACCE发生率显著高于CABG组(P=0.027),主要由于PCI组较CABG组显著升高的再次血运重建率(P<0.001),死亡、心肌梗死经校正后两组间差异无统计学意义。结论:CABG较PCI治疗高龄ULMCA患者的卒中发生率及心源性死亡、卒中、心肌梗死联合终点发生率显著升高,PCI组再次血运重建率显著升高。
Objective: This study aimed at comparing the long-term real-world outcomes of consecutive elderly patients with ULMCA disease underwent PCI with DES and CABG. Methods: Eligible patients(≥65) with unprotected LMCA disease(defined as stenosis ≥50%) who received drug-eluting stents(DES) implantation or underwent CABG between January 2003 to July 2009 in Beijing An Zhen Hospital were consecutively enrolled. 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: 427 patients with ULMCA disease in Beijing An Zhen Hospital were finally enrolled for the analyses;210 patients were treated with PCI using DES(PCI group) and 217 patients were treated with CABG(CABG group). The median follow-up was 7.0 years(interquartile range 5.2 to 8.1 years) in the overall patients. The crude relative risk are as follows. The occurrences of stroke(P=0.009)and the composite of serious outcomes(cardiac death, MI, or stroke)(P=0.048) were significantly higher with the CABG group, whereas the rate of repeat revascularization(P<0.001) was significantly higher in the PCI group. There was a higher trend towards higher rate of death with the CABG group(P=0.079). No significant difference was observed in the rate of MI, cadiac death and MACCE. After multivariate adjusting, there was no significant difference in rates of death, cardiac death and MI between the 2 groups. Rates of MACCE were significantly higher in the PCI group(P=0.027), in large part because of an increased rate of repeat revascularization(P<0.001). However, stroke(P=0.011)and the composite of serious outcomes(cardiac death, MI, or stroke)(P=0.048) were still significantly more likely to occur with CABG. Conclusions: During a median follow-up of 7.0 years, we found that there were significantly higher rate of stroke and the composite of ca
作者
玉献鹏
李宇
金泽宁
何继强
吴长燕
苑飞
黄方炯
顾承雄
孙立忠
YU Xianpeng;LI Yu;JIN Zening;HE Jiqiang;WU Changyan;YUAN Fei;HUANG Fangjiong;GU Chenxiong;SUN Lizhong(Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China)
出处
《心肺血管病杂志》
2019年第6期611-615,628,共6页
Journal of Cardiovascular and Pulmonary Diseases
关键词
无保护左主干病变
经皮冠状动脉介入术
冠状动脉旁路移植术
高龄
Unprotected left main coronary artery
Percutaneous coronary intervention
Coronary artery bypass artery
Elderly
