Spertus John A, Nerella Ravi, Kettlekamp Richard, House John, Marso Steve, Borkon A Michael, Rumsfeld John S
Mid America Heart Institute of Saint Luke's Hospital and the University of Missouri, 4401 Wornall Rd, Kansas City, MO 64111, USA.
Circulation. 2005 Feb 15;111(6):768-73. doi: 10.1161/01.CIR.0000155242.70417.60. Epub 2005 Feb 7.
Previous comparisons of percutaneous coronary interventions (PCIs) and coronary artery bypass graft (CABG) surgery have demonstrated similar survival but have also generally found better health status outcomes (symptoms, function, and quality of life) with CABG. The principal limitation of PCI has been the occurrence of restenosis. No previous studies comparing the health status outcomes of PCI and CABG have examined differences in these outcomes as a function of patients' preprocedural risk for restenosis.
We examined the health status outcomes, using the Seattle Angina Questionnaire (SAQ), among 1459 consecutive patients (1027 treated with PCI and 432, with CABG), stratified by their risk for restenosis. In multivariable-adjusted, linear regression analyses, no differences in 1-year angina or quality of life were observed among the 37.4% of patients at low risk for restenosis. However, among the 46.7% at intermediate risk for restenosis, 1-year health status scores were moderately better after CABG surgery compared with PCI (difference in SAQ angina frequency scores favoring CABG=6.1+/-1.7 points, P=0.0003; difference in SAQ quality of life=5.8+/-1.6 points, P=0.0004). Even larger differences in 1-year outcomes favoring CABG surgery were observed in patients at high risk for restenosis (SAQ angina frequency difference=10.8+/-4.2, P=0.01; SAQ quality of life difference=10.8+/-3.9, P=0.006).
The relative health status benefits of CABG surgery compared with PCI increase as the risk of restenosis increases. Although selecting CABG or PCI is complex, preprocedural restenosis risk should be considered. It should also be tested as a means for considering drug-eluting as opposed to bare metal stents in PCI.
以往经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）的比较显示，二者生存率相似，但总体上CABG术后健康状况结局（症状、功能和生活质量）更佳。PCI的主要局限性在于再狭窄的发生。以往比较PCI和CABG健康状况结局的研究均未将这些结局差异作为患者术前再狭窄风险的函数进行考察。
我们使用西雅图心绞痛问卷（SAQ），对1459例连续患者（1027例行PCI治疗，432例行CABG治疗）的健康状况结局进行了研究，并根据其再狭窄风险进行分层。在多变量调整的线性回归分析中，再狭窄低风险的37.4%患者在1年时心绞痛或生活质量方面未观察到差异。然而，在再狭窄中度风险的46.7%患者中，CABG术后1年的健康状况评分相比PCI有适度改善（SAQ心绞痛发作频率评分有利于CABG的差异=6.1±1.7分，P=0.0003；SAQ生活质量差异=5.8±1.6分，P=0.0004）。在再狭窄高风险患者中，观察到1年结局更有利于CABG手术的更大差异（SAQ心绞痛发作频率差异=10.8±4.2，P=0.01；SAQ生活质量差异=10.8±3.9，P=0.006）。
与PCI相比，CABG手术的相对健康状况获益随着再狭窄风险的增加而增加。尽管选择CABG还是PCI很复杂，但术前再狭窄风险应予以考虑。它也应作为在PCI中考虑使用药物洗脱支架而非裸金属支架的一种手段进行测试。
