Szyguła-Jurkiewicz Bozena, Wilczek Krzysztof, Przybylski Roman, Pacholewicz Jerzy, Trzeciak Przemysław, Styn Tomasz, Zembala Marian, Poloński Lech
III Katedra i Oddział Kliniczny Kardiologii, Slaskiej Akademii Medycznej.
Przegl Lek. 2004;61(12):1295-300.
Percutaneous coronary interventions (PCI) and coronary artery bypass grafting (CABG) are well established revascularization methods in stable coronary artery disease and in acute coronary syndromes (ACS) as well.
We analyzed 361 patients hospitalized with clinical diagnosis of ACS without persistent ST segment elevation. Patients had an episode of rest angina in the previous 24 hours and had to fulfil at least one of the criteria: 1. ST segment depression (>0.5 mm), 2. transient ST segment elevation or T-wave inversion (> 1 mm), 3. positive serum cardiac markers. We aimed at assessing the frequency of adverse events (death, myocardial infarction, repeat revascularization unstable angina, cardiovascular hospitalization) during follow-up and determining the predictors of 12-month mortality.
In the analyzed group 284 patients (78.7%) underwent PCI and 77 patients (21.3%) were assigned to CABG. Overall mortality in the PCI group and in the CABG group was 3.5% and 9.1% respectively (p=0.04). In-hospital mortality rate was higher in the CABG group (7.8% vs. 1.8% p<0.02). After discharge mortality rate was 1.8% in the PCI and 1.4% in the CABG group (NS). The rate of MI during follow-up was similar in both groups. Fewer CABG patients had episodes of unstable angina, MI, repeat revascularization and cardiovascular hospitalisation. Independent predictors of death in the PCI group were: post-procedure recurrent angina (OR 2.40; 95%CI 1.20-4.19; p=0.03) and heart failure (OR 4.75; 95%CI 1.80-12.70; p=0.01), while in the CABG group these predictors were: inability to determine culprit vessel (OR 4,29; 95%CI 2.20-15.6; p=0.02) and heart failure (OR 7.70; 95%CI 3.74-21.49; p=0.05).
We observed a higher overall mortality rate at one year in CABG patients, whereas PCI patients had a higher rate of unstable angina, repeat revascularization and cardiovascular hospitalization during 12-month follow-up.
经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）是稳定型冠状动脉疾病以及急性冠状动脉综合征（ACS）中成熟的血运重建方法。
我们分析了361例临床诊断为非持续性ST段抬高型ACS的住院患者。患者在过去24小时内有静息性心绞痛发作，且必须满足至少一项标准：1. ST段压低（>0.5mm）；2. 短暂性ST段抬高或T波倒置（>1mm）；3. 血清心肌标志物阳性。我们旨在评估随访期间不良事件（死亡、心肌梗死、再次血运重建、不稳定型心绞痛、心血管住院）的发生率，并确定12个月死亡率的预测因素。
在分析的组中，284例患者（78.7%）接受了PCI，77例患者（21.3%）接受了CABG。PCI组和CABG组的总死亡率分别为3.5%和9.1%（p=0.04）。CABG组的住院死亡率较高（7.8%对1.8%，p<0.02）。出院后，PCI组的死亡率为1.8%，CABG组为1.4%（无统计学差异）。两组随访期间的心肌梗死发生率相似。接受CABG的患者发生不稳定型心绞痛、心肌梗死、再次血运重建和心血管住院的情况较少。PCI组死亡的独立预测因素为：术后复发性心绞痛（OR 2.40；95%CI 1.20-4.19；p=0.03）和心力衰竭（OR 4.75；95%CI 1.80-12.70；p=0.01），而在CABG组中，这些预测因素为：无法确定罪犯血管（OR 4.29；95%CI 2.20-15.6；p=0.02）和心力衰竭（OR 7.70；95%CI 3.74-21.49；p=0.05）。
我们观察到CABG患者1年时的总死亡率较高，而PCI患者在12个月随访期间不稳定型心绞痛、再次血运重建和心血管住院的发生率较高。
