对于适合冠状动脉旁路移植手术的非糖尿病患者，意向性不完全经皮腔内冠状动脉血管成形术血运重建策略是否可接受？旁路血管成形术血运重建调查（BARI）。

Is a strategy of intended incomplete percutaneous transluminal coronary angioplasty revascularization acceptable in nondiabetic patients who are candidates for coronary artery bypass graft surgery? The Bypass Angioplasty Revascularization Investigation (BARI).

作者信息

Bourassa M G, Kip K E, Jacobs A K, Jones R H, Sopko G, Rosen A D, Sharaf B L, Schwartz L, Chaitman B R, Alderman E L, Holmes D R, Roubin G S, Detre K M, Frye R L

机构信息

Department of Medicine, Montreal Heart Institute, Canada.

出版信息

J Am Coll Cardiol. 1999 May;33(6):1627-36. doi: 10.1016/s0735-1097(99)00077-7.

DOI:10.1016/s0735-1097(99)00077-7

PMID:10334434

Abstract

OBJECTIVES

Our objective was to determine whether a strategy of intended incomplete percutaneous transluminal coronary angioplasty revascularization (IR) compromises long-term patient outcome.

BACKGROUND

Complete angioplasty revascularization (CR) is often not planned nor attempted in patients with multivessel coronary disease, and the extent to which this influences outcome is unclear.

METHODS

Before randomization, in the Bypass Angioplasty Revascularization Investigation, all angiograms were assessed for intended CR or IR via angioplasty. Outcomes were compared among patients with IR intended if assigned to angioplasty, randomized to coronary artery bypass graft surgery (CABG) versus angioplasty; and within angioplasty patients only, among patients with IR versus CR intended.

RESULTS

At 5 years, there was a trend for higher overall (88.6% vs. 84.0%) and cardiac survival (94.5% vs. 92.1%) in CABG versus angioplasty patients with IR intended. The excess mortality in angioplasty patients occurred solely in diabetic subjects; overall and cardiac survival were similar among nondiabetic CABG and angioplasty patients. Freedom from myocardial infarction (MI) at 5 years was higher in nondiabetic CABG versus angioplasty patients (92.4% vs. 85.2%, p = 0.02), vet was similar to the rate observed (85%) in nondiabetic CABG and angioplasty patients with CR intended. Five-year rates of death, cardiac death, repeat revascularization and angina were similar in all angioplasty patients with IR versus CR intended. However, a trend for greater freedom from subsequent CABG was seen in CR patients (70.3% vs. 64.0%, p = 0.08).

CONCLUSIONS

Intended incomplete angioplasty revascularization in nondiabetic patients with multivessel disease who are candidates for both angioplasty and CABG does not compromise long-term survival; however, subsequent need for CABG may be increased with this strategy. Whether the risk of long-term MI is also increased remains uncertain.

摘要

目的

我们的目的是确定意向性不完全经皮冠状动脉腔内血管成形术血运重建（IR）策略是否会影响患者的长期预后。

背景

多支冠状动脉疾病患者通常不计划也不尝试进行完全血管成形术血运重建（CR），而这对预后的影响程度尚不清楚。

方法

在旁路血管成形术血运重建调查中，随机分组前，通过血管成形术对所有血管造影进行评估，以确定是意向性CR还是IR。比较了若分配到血管成形术则意向性IR的患者、随机分配到冠状动脉旁路移植术（CABG）与血管成形术的患者；以及仅在血管成形术患者中，意向性IR与CR的患者之间的预后。

结果

5年时，意向性IR的CABG患者与血管成形术患者相比，总体生存率（88.6%对84.0%）和心脏生存率（94.5%对92.1%）有升高趋势。血管成形术患者的额外死亡率仅发生在糖尿病患者中；非糖尿病CABG和血管成形术患者的总体生存率和心脏生存率相似。非糖尿病CABG患者5年无心肌梗死（MI）发生率高于血管成形术患者（92.4%对85.2%，p = 0.02），但与意向性CR的非糖尿病CABG和血管成形术患者中观察到的发生率（85%）相似。意向性IR与CR的所有血管成形术患者的5年死亡率、心脏性死亡、再次血运重建和心绞痛发生率相似。然而，CR患者后续免于CABG的趋势更明显（70.3%对64.0%，p = 0.08）。