Zhang Zefeng, Spertus John A, Mahoney Elizabeth M, Booth Jean, Nugara Fiona, Stables Rodney H, Weintraub William S
Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30306, USA.
Am Heart J. 2005 Jul;150(1):175-81. doi: 10.1016/j.ahj.2005.01.019.
Data are limited regarding the impact of acute coronary syndromes (ACSs) on the relative benefits of coronary artery bypass grafting (CABG) versus stent-assisted percutaneous coronary intervention (PCI).
The SoS trial compared patients with multivessel disease who were randomly assigned to CABG (n = 500) or stent-assisted PCI (n = 488). The impact of treatment on 1-year outcomes was compared in ACS (n = 126, CABG; n = 116, PCI) and non-ACS (n = 374, CABG; n = 372, PCI) subgroups.
Baseline characteristics were similar between treatment groups within ACS and non-ACS groups, as was the 1-year composite incidence of mortality and myocardial infarction (ACS, 5.2% for PCI vs 5.6% for CABG, P = .89; non-ACS, 7.0% vs 8.3%, P = .50). The need for repeat revascularizations was higher after PCI versus CABG within each subgroup (ACS, 15.5% vs 7.1%, P = .04; non-ACS, 18.0% vs 3.2%, P < .001). At 6 and 12 months, scores on the Seattle Angina Questionnaire improved significantly in patients with and without ACS. In patients without ACS, CABG was associated with greater improvement in physical limitation, angina frequency, and quality of life at 6 and 12 months. In patients with ACS, there was only a nonsignificant slight trend toward greater improvement with CABG at 1 year. The total 1-year costs for PCI and CABG in patients without ACS were 5760 pound sterling and 8509 pound sterling (Delta = 2749 pound sterling, 95% CI 1890 pound sterling - 3409 pound sterling), and in patients with ACS, 8014 pound sterling and 10080 pound sterling (Delta = 2066 pound sterling, 95% CI -690 pound sterling to 3487 pound sterling).
In patients with and without ACS, CABG had similar clinical outcomes, less need for repeat revascularization and higher costs compared to PCI. The benefit of CABG relative to PCI in improving patients' health status tended to be greater in patients without ACS than in patients with ACS.
关于急性冠状动脉综合征（ACS）对冠状动脉旁路移植术（CABG）与支架辅助经皮冠状动脉介入治疗（PCI）相对获益的影响，数据有限。
SoS试验比较了多支血管病变患者，这些患者被随机分配至CABG组（n = 500）或支架辅助PCI组（n = 488）。在ACS亚组（n = 126，CABG；n = 116，PCI）和非ACS亚组（n = 374，CABG；n = 372，PCI）中比较了治疗对1年结局的影响。
ACS组和非ACS组内治疗组之间的基线特征相似，1年死亡率和心肌梗死的综合发生率也相似（ACS，PCI组为5.2%，CABG组为5.6%，P = 0.89；非ACS，7.0%对8.3%，P = 0.50）。在每个亚组中，PCI术后再次血运重建的需求高于CABG（ACS，15.5%对7.1%，P = 0.04；非ACS，18.0%对3.2%，P < 0.001）。在6个月和12个月时，有或无ACS患者的西雅图心绞痛问卷评分均有显著改善。在无ACS患者中，CABG与6个月和12个月时身体受限、心绞痛频率及生活质量的更大改善相关。在有ACS患者中，1年时CABG仅有非显著的稍大改善趋势。无ACS患者中PCI和CABG的1年总费用分别为5760英镑和8509英镑（差值 = 2749英镑，95%CI 1890英镑 - 3409英镑），有ACS患者中分别为8014英镑和10080英镑（差值 = 2066英镑，95%CI -690英镑至3487英镑）。
在有和无ACS的患者中，与PCI相比，CABG有相似的临床结局、更少的再次血运重建需求及更高的费用。与PCI相比，CABG在改善患者健康状况方面的获益在无ACS患者中往往比有ACS患者更大。
