Zhang Zefeng, Weintraub William S, Mahoney Elizabeth M, Spertus John A, Booth Jean, Nugara Fiona, Stables Rodney H, Vaccarino Viola
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia 30306, USA.
Am J Cardiol. 2004 Feb 15;93(4):404-9. doi: 10.1016/j.amjcard.2003.10.032.
Information on the relative benefit of coronary artery bypass grafting (CABG) versus stent-assisted percutaneous coronary intervention (PCI) for improvement of cardiac-related health status in women and how it compares with men is limited. The Stent or Surgery trial compared randomly assigned CABG and stent-assisted PCI in 206 women and 782 men with multivessel disease. We examined longitudinal changes at 6 and 12 months from baseline by gender and treatment in 3 subscales of the Seattle Angina Questionnaire (SAQ): physical limitation, angina frequency, and quality of life. At the time of revascularization, women were older, more severely ill, and tended to have lower SAQ scores than men. At 6 months, SAQ scores after both procedures improved significantly in both genders, with greater improvement achieved with CABG. After adjustment for other factors, in men, CABG was associated with a 54.7% greater improvement in physical limitation compared with PCI, 31.3% greater improvement in angina frequency, and 18.3% greater improvement in quality of life. In women, these relative differences were 11.6%, 43.2%, and 39.3%, respectively. At 1 year, men continued to show greater improvement with CABG in all 3 dimensions (50.6%, 19.7%, and 15.3%, respectively), but in women the relative differences decreased substantially (1.6%, 11.1%, and 0.6%, respectively) due to a greater later improvement after PCI (p = 0.049 for the interaction among treatment, gender, and follow-up for the quality of life domain). Although CABG may be superior to PCI in men, in women, at 1 year after intervention, both procedures appear equally effective.
关于冠状动脉搭桥术（CABG）与支架辅助经皮冠状动脉介入治疗（PCI）相比，在改善女性心脏相关健康状况方面的相对益处以及与男性的比较情况，目前信息有限。“支架或手术”试验对206名女性和782名患有多支血管病变的男性进行了随机分组，比较了CABG和支架辅助PCI。我们通过性别和治疗方式，在西雅图心绞痛问卷（SAQ）的3个分量表（身体限制、心绞痛发作频率和生活质量）中，研究了从基线开始6个月和12个月时的纵向变化。在血运重建时，女性年龄更大，病情更严重，SAQ评分往往低于男性。6个月时，两种手术术后SAQ评分在两性中均显著改善，CABG的改善程度更大。在对其他因素进行调整后，在男性中，与PCI相比，CABG在身体限制方面的改善程度高54.7%，在心绞痛发作频率方面高31.3%，在生活质量方面高18.3%。在女性中，这些相对差异分别为11.6%、43.2%和39.3%。1年时，男性在所有3个维度上CABG仍显示出更大改善（分别为50.6%、19.7%和15.3%），但在女性中，由于PCI术后后期改善更大，相对差异大幅下降（生活质量领域治疗、性别和随访之间的交互作用p = 0.049）。尽管CABG在男性中可能优于PCI，但在女性中，干预后1年时，两种手术似乎同样有效。
