Bair Tami L, Muhlestein Joseph B, May Heidi T, Meredith Kent G, Horne Benjamin D, Pearson Robert R, Li Qunyu, Jensen Kurt R, Anderson Jeffrey L, Lappé Donald L
Cardiovascular Department, University of Utah, Salt Lake City, USA.
Circulation. 2007 Sep 11;116(11 Suppl):I226-31. doi: 10.1161/CIRCULATIONAHA.106.681346.
Coronary artery bypass surgery (CABG) and percutaneous coronary intervention with stenting (PCI-S) are both safe and effective approaches for revascularization in patients with multivessel coronary artery disease. However, conflicting information exists when comparing the efficacy of the two methods. In this study, we examined the outcomes of major adverse cardiovascular events and death for subgroups of typical "real-world" patients undergoing coronary revascularization in the modern era.
Patients were included if they were revascularized by CABG or PCI-S, had > or = 5 years of follow-up, and had > or = 2-vessel disease. Patients were followed for an average of 7.0+/-3.2 years for incidence of death and major adverse cardiovascular events (death, myocardial infarction, or repeat revascularization). Multivariate regression models were used to correct for standard cardiac risk factors including age, sex, hyperlipidemia, diabetes mellitus, family history of coronary artery disease, smoking, hypertension, heart failure, and renal failure. Subgroup analyses were also performed, stratified by age, sex, diabetes, ejection fraction, and history of PCI-S, CABG, or myocardial infarction. A total of 6369 patients (CABG 4581; PCI-S 1788) were included. Age averaged 66+/-10.9 years, 76% were male, and 26% were diabetic. Multivariate risk favored CABG over PCI-S for both death (hazard ratio 0.85; P=0.001) and major adverse cardiovascular events (hazard ratio 0.51; P<0.0001). A similar advantage with CABG was also found in most substrata, including diabetes.
In this large observational study of patients undergoing revascularization for multivessel coronary artery disease, a long-term benefit was found, in relationship to both death and major adverse cardiovascular events, for CABG over PCI-S regardless of diabetic status or other stratifications.
冠状动脉搭桥手术（CABG）和经皮冠状动脉介入支架置入术（PCI-S）都是多支冠状动脉疾病患者血运重建的安全有效方法。然而，在比较这两种方法的疗效时存在相互矛盾的信息。在本研究中，我们考察了现代进行冠状动脉血运重建的典型“真实世界”患者亚组的主要不良心血管事件和死亡结局。
纳入通过CABG或PCI-S进行血运重建、随访时间≥5年且患有≥双支血管疾病的患者。对患者平均随访7.0±3.2年，观察死亡和主要不良心血管事件（死亡、心肌梗死或再次血运重建）的发生率。使用多变量回归模型校正包括年龄、性别、高脂血症、糖尿病、冠状动脉疾病家族史、吸烟、高血压、心力衰竭和肾衰竭在内的标准心脏危险因素。还按年龄、性别、糖尿病、射血分数以及PCI-S、CABG或心肌梗死病史进行亚组分析。共纳入6369例患者（CABG组4581例；PCI-S组1788例）。平均年龄为66±10.9岁，76%为男性，26%患有糖尿病。多变量风险显示，在死亡（风险比0.85；P=0.001）和主要不良心血管事件（风险比0.51；P<0.0001）方面，CABG优于PCI-S。在大多数亚组中，包括糖尿病亚组，也发现CABG具有类似优势。
在这项对多支冠状动脉疾病患者进行血运重建的大型观察性研究中，发现无论糖尿病状态或其他分层情况如何，CABG在死亡和主要不良心血管事件方面均优于PCI-S，具有长期益处。
