梅斯医学MedSci APP
医路相伴，成就大医
梅斯医学MedSci APP
医路相伴，成就大医
2011年12月Ann Thorac Surg杂志刊登了美国研究人员对冠状动脉旁路移植术（CABG）和支架经皮冠状动脉介入治疗（PCI）患者随访5年以上的相对存活率数据进行的比较分析研究成果"Long-term mortality of coronary artery bypass grafting and bare-metal stenting"。结果显示，与裸金属支架相比，多支冠脉病变患者行CABG后长期(8年)死亡率风险更低。
CABG与PCI孰优孰劣的争论由来已久，研究纳入了纽约1999-2000年间行CABG的多支血管病变患者18,359例，接受裸金属支架置入的患者13,377例。利用“全国死亡指数(NDI)”跟踪患者生命状态至2007年。根据多种患者特征，按患者病变冠状血管数量、近端左前降支 (LAD)动脉疾病和CABG倾向性对CABG患者和支架患者进行匹配，比较两种手术的存活率。
7,235对匹配患者8年总存活率分别为，CABG 78.0% ，支架置入71.2% (风险比[HR]，0.68; 95%可信区间[CI]，0.64-0.74; p < 0.001)。根据病变血管数量及近端LAD受累类进行解剖学分组，3支血管病变累及近端LAD动脉疾病患者的风险为0.53(p < 0.001)，而2支血管病变但无LAD动脉疾病患者风险比为0.78 (p=0.05)。所有按基线风险因素数量分层的亚组，CABG后死亡风险均较低。（生物谷bioon.com）
doi:10.1016/j.athoracsur.2011.06.061
Long-term mortality of coronary artery bypass grafting and bare-metal stenting
Wu C, Zhao S, Wechsler AS, Lahey S, Walford G, Culliford AT, Gold JP, Smith CR, Holmes DR Jr, King SB 3rd, Higgins RS, Jordan D, Hannan EL.
BACKGROUND:
There is little information on relative survival with follow-up longer than 5 years in patients undergoing coronary artery bypass grafting (CABG) and patients undergoing percutaneous coronary intervention (PCI) with stenting. This study tested the hypothesis that CABG is associated with a lower risk of long-term (8-year) mortality than is stenting with bare-metal stents for multivessel coronary disease.
METHODS:
We identified 18,359 patients with multivessel disease who underwent isolated CABG and 13,377 patients who received bare-metal stenting in 1999 to 2000 in New York and followed their vital status through 2007 using the National Death Index (NDI). We matched CABG and stent patients on the number of diseased coronary vessels, proximal left anterior descending (LAD) artery disease, and propensity of undergoing CABG based on numerous patient characteristics and compared survival after the 2 procedures.
RESULTS:
In the 7,235 pairs of matched patients, the overall 8-year survival rates were 78.0% for CABG and 71.2% for stenting (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.64 to 0.74; p < 0.001). For anatomic groups classified by the number of diseased vessels and proximal LAD involvement, the HRs ranged from 0.53 (p < 0.001) for patients with 3-vessel disease involving proximal LAD artery disease to 0.78 (p = 0.05) for patients with 2-vessel disease but no disease in the LAD artery. A lower risk of death after CABG was observed in all subgroups stratified by a number of baseline risk factors.
CONCLUSIONS:
Coronary artery bypass grafting is associated with a lower risk of death than is stenting with bare metal stents for multivessel coronary disease.
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