Drenth Derk J, Veeger Nic J G M, Grandjean Jan G, Mariani Massimo A, van Boven Ad J, Boonstra Piet W
Thoraxcentre, Groningen University Hospital, Groningen, The Netherlands.
Eur J Cardiothorac Surg. 2004 Apr;25(4):567-71. doi: 10.1016/j.ejcts.2004.01.015.
The objective of this study was to compare the long-term outcome of patients with an isolated high-grade stenosis of the left anterior descending (LAD) coronary artery randomized to percutaneous transluminal coronary angioplasty with stenting (PCI, stenting) or to off-pump coronary artery bypass grafting (surgery).
Patients with an isolated high-grade stenosis (American College of Cardiology/American Heart Association classification type B2/C) of the proximal LAD were randomly assigned to stenting (n=51) or to surgery (n=51) and were followed for 3-5 years (mean 4 years). Primary composite endpoint was freedom from major adverse cardiac and cerebrovascular events (MACCEs), including cardiac death, myocardial infarction, stroke and repeat target vessel revascularization. Secondary endpoints were angina pectoris status and need for anti-anginal medication at follow-up. Analysis was by intention to treat.
MACCEs occurred in 27.5% after stenting and 9.8% after surgery (P=0.02; absolute risk reduction 17.7%). Freedom from angina pectoris was 67% after stenting and 85% after surgery (P=0.036). Need for anti-anginal medication was significantly lower after surgery compared to stenting (P=0.002).
Patients with an isolated high-grade lesion of the proximal LAD have a significantly better 4-year clinical outcome after off-pump coronary bypass grafting than after PCI.
本研究的目的是比较孤立性左前降支（LAD）冠状动脉重度狭窄患者随机接受经皮冠状动脉腔内血管成形术加支架置入术（PCI，支架置入术）或非体外循环冠状动脉旁路移植术（手术）后的长期结局。
将孤立性近端LAD重度狭窄（美国心脏病学会/美国心脏协会分类为B2/C型）的患者随机分配至支架置入组（n = 51）或手术组（n = 51），并随访3至5年（平均4年）。主要复合终点是无主要不良心脑血管事件（MACCE），包括心源性死亡、心肌梗死、中风和再次靶血管血运重建。次要终点是随访时的心绞痛状态和抗心绞痛药物需求。分析采用意向性治疗。
支架置入术后MACCE发生率为27.5%，手术后为9.8%（P = 0.02；绝对风险降低17.7%）。支架置入术后无心绞痛的比例为67%，手术后为85%（P = 0.036）。与支架置入术相比，手术后抗心绞痛药物需求显著更低（P = 0.002）。
孤立性近端LAD重度病变患者非体外循环冠状动脉旁路移植术后4年的临床结局明显优于PCI术后。
