Hueb W A, Soares P R, Almeida De Oliveira S, Ariê S, Cardoso R H, Wajsbrot D B, Cesar L A, Jatene A D, Ramires J A
Heart Institute of the University of São Paulo, São Paulo, Brazil.
Circulation. 1999 Nov 9;100(19 Suppl):II107-13. doi: 10.1161/01.cir.100.suppl_2.ii-107.
Although coronary angioplasty and myocardial bypass surgery are routinely used, there is no conclusive evidence that these interventional methods offer greater benefit than medical therapy alone. This study is intended to evaluate, in a prospective, randomized, and comparative analysis, the benefit of the 3 current therapeutic strategies for patients with stable angina and single proximal left anterior descending coronary artery stenosis.
In a single institution, 214 patients with stable angina, normal ventricular function, and severe proximal stenosis (>80%) on the left anterior descending artery were selected for the study. After random assignment, 70 patients were referred to surgical treatment, 72 to angioplasty, and 72 to medical treatment. The primary end points were the occurrence of acute myocardial infarction or death and presence of refractory angina. After a 5-year follow-up, these combined events were reported in only 6 patients referred to surgery as compared with 29 patients treated with angioplasty and 17 patients who only received medical treatment (P=0.001). However, no differences were noted in relation to the occurrence of cardiac-related death in the 3 treatment groups (P=0. 622). No patient assigned to surgery needed repeat operation, whereas 8 patients assigned to angioplasty and 8 patients assigned to medical treatment required surgical bypass after the initial random assignment. Surgery and angioplasty reduced anginal symptoms and stress-induced ischemia considerably. However, all 3 treatments effectively improved limiting angina.
Bypass surgery for single-vessel coronary artery disease is associated with a lower incidence of medium-term and long-term events as well as fewer anginal symptoms than that found in the patients who underwent angioplasty or medical therapy. In this study, coronary angioplasty was only superior to medical strategies in relation to the anginal status. However, the 3 treatment regimens yielded a similar incidence of acute myocardial infarction and death. Such information should be useful when choosing the best therapeutic option for similar patients.
尽管冠状动脉血管成形术和心肌搭桥手术已被常规使用，但尚无确凿证据表明这些介入方法比单纯药物治疗能带来更大益处。本研究旨在通过前瞻性、随机和对比分析，评估目前三种治疗策略对稳定型心绞痛且左前降支冠状动脉近端单处狭窄患者的益处。
在一家机构中，选取了214例稳定型心绞痛、心室功能正常且左前降支动脉近端严重狭窄（>80%）的患者进行研究。随机分组后，70例患者接受手术治疗，72例接受血管成形术，72例接受药物治疗。主要终点是急性心肌梗死或死亡的发生以及顽固性心绞痛的存在。经过5年随访，接受手术治疗的患者中只有6例出现这些联合事件，而接受血管成形术治疗的患者有29例，仅接受药物治疗的患者有17例（P=0.001）。然而，三个治疗组中心脏相关死亡的发生率没有差异（P=0.622）。接受手术治疗的患者无需再次手术，而在最初随机分组后，接受血管成形术治疗的8例患者和接受药物治疗的8例患者需要进行外科搭桥手术。手术和血管成形术显著减轻了心绞痛症状和应激诱导的缺血。然而，所有三种治疗方法均有效改善了限制性心绞痛。
单支冠状动脉疾病的搭桥手术与中期和长期事件的发生率较低以及心绞痛症状较少相关，与接受血管成形术或药物治疗的患者相比。在本研究中，冠状动脉血管成形术仅在心绞痛状况方面优于药物治疗策略。然而，三种治疗方案的急性心肌梗死和死亡发生率相似。这些信息在为类似患者选择最佳治疗方案时应会有所帮助。
