Mack Michael J, Prince Syma L, Herbert Morley, Brown Phillip P, Katz Marc, Palmer George, Edgerton James R, Eichhorn Eric, Magee Mitchell J, Dewey Todd M
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA.
Ann Thorac Surg. 2008 Aug;86(2):496-503; discussion 503. doi: 10.1016/j.athoracsur.2008.03.060.
Randomized trials have compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). However, results of these trials in select patients may not accurately reflect current clinical practice using drug-eluting stents (DES) and off-pump CABG. We undertook a prospective registry of coronary revascularization by CABG on-pump and off-pump, and PCI with or without DES, to determine clinical outcomes.
All patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. Preprocedural, intraprocedural, and postprocedural data were captured, with outcomes obtained at 18 months by patient and physician contact, and the Social Security Death Index.
The study enrolled 4336 patients, 71.2% PCI and 28.8% CABG. DESs were used in 2249 PCIs (73.1%), and 596 CABG procedures (47.8%) were off-pump. Incidence of major adverse cardiac events at 18 months was 14.7% for CABG vs 23.3% for PCI (p < 0.001). Cardiac death and myocardial infarction had similar rates. The need for repeat revascularization was significantly less with CABG (6.2% vs 13.6%, p < 0.001). Hazard ratio of CABG to PCI was 0.76 (95% confidence interval, 0.571 to 0.872). CABG outcome was similar on-pump and off-pump, as was repeat revascularization with DES (12.1%) vs BMS (14.9%; p = 0.096). Overall event-free survival was 85.3% in CABG and 76.8% in PCI (p < 0.001).
Rates of repeat revascularization were significantly higher for PCI than for CABG, but mortality and myocardial infarction were the same. There were no significant differences in outcomes between DES and BMS or between on-pump and off-pump CABG.
随机试验已对冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）进行了比较。然而，这些试验在特定患者中的结果可能无法准确反映当前使用药物洗脱支架（DES）和非体外循环CABG的临床实践。我们进行了一项前瞻性登记研究，纳入了接受体外循环CABG、非体外循环CABG以及使用或不使用DES的PCI的冠状动脉血运重建患者，以确定临床结局。
纳入8家社区医院所有接受单纯冠状动脉血运重建的患者。收集术前、术中和术后数据，通过与患者和医生联系以及社会保障死亡指数在18个月时获取结局。
该研究共纳入4336例患者，其中71.2%接受PCI，28.8%接受CABG。2249例PCI（73.1%）使用了DES，596例CABG手术（47.8%）为非体外循环。18个月时，CABG的主要不良心脏事件发生率为14.7%，PCI为23.3%（p<0.001）。心源性死亡和心肌梗死发生率相似。CABG再次血运重建的需求显著低于PCI（6.2%对13.6%，p<0.001）。CABG与PCI的风险比为0.76（95%置信区间，0.571至0.872）。体外循环和非体外循环CABG的结局相似，DES再次血运重建（12.1%）与裸金属支架（BMS，14.9%；p=0.096）相似。CABG的总体无事件生存率为85.3%，PCI为76.8%（p<0.001）。
PCI再次血运重建率显著高于CABG，但死亡率和心肌梗死发生率相同。DES与BMS之间以及体外循环与非体外循环CABG之间的结局无显著差异。
