Reynolds Matthew R, Neil Nancy, Ho Kalon K L, Berezin Ronna, Cosgrove Roberta S, Lager Robert A, Sirois Cheryl, Johnson Robert G, Cohen David J
Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Am Heart J. 2003 Feb;145(2):334-42. doi: 10.1067/mhj.2003.38.
Randomized trials comparing multivessel stenting with coronary artery bypass surgery (CABG) have demonstrated similar rates of death and myocardial infarction but higher rates of repeat revascularization after stenting. The impact of these alternative strategies on overall medical care costs is uncertain, particularly within the US health care system.
We performed a retrospective, matched cohort study to compare the clinical and economic outcomes of multivessel stenting and bypass surgery. The stent group consisted of 100 consecutive patients who underwent stenting of >or=2 major native coronary arteries at our institution. The CABG group consisted of 200 patients who underwent nonemergent isolated bypass surgery during the same time frame, matched (2:1) for age, sex, ejection fraction, diabetes mellitus, and extent of coronary disease. Detailed clinical follow-up and resource utilization data were collected for a minimum of 2 years. Total costs were calculated by use of year 2000 unit prices.
Over a median follow up period of 2.8 years, there were no significant differences in all-cause mortality rates (3.0% vs 3.0%), Q-wave myocardial infarction (5.1% vs 4.0%), or the composite of death or myocardial infarction (7.1% vs 7.0%) between the stent and CABG groups (P = not significant for all comparisons). However, at 2-year follow up, patients with stents were more likely to require >or=1 repeat revascularization procedure (32.0% vs 4.5%, P <.001). The initial cost of multivessel stenting was 43% less than the cost of CABG (11,810 dollars vs 20,574 dollars, P <.001) and remained 27% less (17,634 dollars vs 24,288 dollars, P =.005) at 2 years.
Multivessel stenting and CABG result in comparable risks of death and myocardial infarction. Despite a higher rate of repeat revascularization, multivessel stenting was significantly less costly than CABG through the first 2 years of follow-up.
比较多支血管支架置入术与冠状动脉旁路移植术（CABG）的随机试验表明，两者的死亡和心肌梗死发生率相似，但支架置入术后再次血运重建的发生率更高。这些替代策略对总体医疗费用的影响尚不确定，尤其是在美国医疗保健系统中。
我们进行了一项回顾性配对队列研究，以比较多支血管支架置入术和搭桥手术的临床及经济结果。支架组由在我们机构连续接受≥2支主要冠状动脉支架置入术的100例患者组成。CABG组由200例在同一时间段内接受非急诊单纯搭桥手术的患者组成，根据年龄、性别、射血分数、糖尿病和冠状动脉疾病程度进行配对（2:1）。收集详细的临床随访和资源利用数据，至少随访2年。总成本按照2000年的单价计算。
在中位随访期2.8年期间，支架组和CABG组之间的全因死亡率（3.0%对3.0%）、Q波心肌梗死（5.1%对4.0%）或死亡或心肌梗死的复合发生率（7.1%对7.0%）无显著差异（所有比较P均无统计学意义）。然而，在2年随访时，接受支架置入术的患者更有可能需要≥1次再次血运重建手术（32.0%对4.5%，P<.001）。多支血管支架置入术的初始成本比CABG低43%（11,810美元对20,574美元，P<.001），在2年时仍低27%（17,634美元对24,288美元，P=.005）。
多支血管支架置入术和CABG导致的死亡和心肌梗死风险相当。尽管再次血运重建的发生率较高，但在随访的前2年中，多支血管支架置入术的成本显著低于CABG。
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