Li Yan, Zheng Zhe, Xu Bo, Zhang Shiju, Li Wei, Gao Runlin, Hu Shengshou
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Circulation. 2009 Apr 21;119(15):2040-50. doi: 10.1161/CIRCULATIONAHA.108.819730. Epub 2009 Apr 6.
Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003, drug-eluting stents were introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery. The long-term outcome of drug-eluting stents compared with that of CABG surgery is also unclear.
We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction, and stroke) and efficacy (target-vessel revascularization) during a 3-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors. Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients receiving drug-eluting stents had considerably higher 3-year rates of target-vessel revascularization. Drug-eluting stents were also associated with higher rates of death (adjusted hazard ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and myocardial infarction (adjusted hazard ratio, 1.65; 95% confidence interval, 1.15 to 2.44). The risk adjusted rate of stroke was similar in the 2 groups (hazard ratio, 0.92; 95% confidence interval, 0.69 to 1.51).
In a cohort of patients with multivessel disease, CABG was associated with lower rates of death, myocardial infarction, and target-vessel revascularization than drug-eluting stents.
众多研究比较了冠状动脉旁路移植术(CABG)与冠状动脉支架置入术治疗多支冠状动脉疾病的疗效。2003年,药物洗脱支架问世,期望能降低再狭窄率。然而,关于药物洗脱支架与CABG手术比较的信息有限。药物洗脱支架与CABG手术相比的长期疗效也不明确。
我们纳入了2004年4月1日至2005年12月31日期间连续接受单纯CABG手术或药物洗脱支架治疗的3720例多支血管疾病患者,并比较了3年随访期间的安全性(全因死亡率、心肌梗死和卒中)和疗效(靶血管血运重建)。在对基线危险因素差异进行校正后比较这些结果。接受CABG手术的患者(n = 1886)比接受药物洗脱支架的患者(n = 1834)年龄更大,合并症更多。接受药物洗脱支架的患者3年靶血管血运重建率显著更高。药物洗脱支架还与更高的死亡率(校正风险比,1.62;95%置信区间,1.07至2.47)和心肌梗死发生率(校正风险比,1.65;95%置信区间,1.15至2.44)相关。两组的风险校正卒中发生率相似(风险比,0.92;95%置信区间,0.69至1.51)。
在一组多支血管疾病患者中,与药物洗脱支架相比,CABG手术的死亡、心肌梗死和靶血管血运重建发生率更低。