Buszman Pawel, Wiernek Szymon, Szymanski Radoslaw, Bialkowska Bozena, Buszman Piotr, Fil Wojciech, Stables Rodney, Bochenek Andrzej, Martin Jack, Tendera Michal
Upper Silesian Medical Center, 45-47 Ziolowa, 40-635 Katowice, Poland.
Catheter Cardiovasc Interv. 2009 Sep 1;74(3):420-6. doi: 10.1002/ccd.22015.
To compare 10 year outcomes including death, left ventricular ejection fraction (LVEF), major adverse cardiovascular and cerebrovascular events (MACCE), repeat revascularization (RR), and severity of angina (CCS) after randomization to stent supported percutaneous coronary intervention (PCI) or surgical revascularization (CABG) in a single center participating in the SOS trial.
Randomized studies show increased RR following PCI, but otherwise similar results to CABG in selected mutlivessel disease patients with up to 5 year follow up. There is no 10 year data available.
The analysis involved 100 patients randomized into the SOS study in Poland.
Patients were well matched for baseline demographic and angiographic characteristics. During 9.6 +/- 0.85 year observation, there was no significant difference between groups for survival, CCS, and LVEF. Increased RR occurred following PCI; 21 (42%) vs. 9 (18%), P < 0.05. As a consequence, the MACCE was also significantly higher following PCI; 36 (72%) vs. 28 (56%), P < 0.05. Excess RR predominantly occurred in the first year and diminished over time with numerically less RR following PCI from year 5 to 10; 2 (4%) vs. 7 (14%), P = ns.
These findings suggest that patients with multivessel coronary artery disease technically suitable for either stent supported PCI or CABG have very similar 10 year outcomes with respect to mortality, angina class, LVEF, and MACCE other than RR. Excess RR following PCI predominantly occurs in early years and is numerically lower following PCI in years 5-10. This underscores the need for longer-term follow up from randomized trials.
在参与SOS试验的单一中心，比较随机接受支架辅助经皮冠状动脉介入治疗（PCI）或外科血运重建（冠状动脉旁路移植术，CABG）后10年的结局，包括死亡、左心室射血分数（LVEF）、主要不良心血管和脑血管事件（MACCE）、再次血运重建（RR）以及心绞痛严重程度（加拿大心血管学会分级，CCS）。
随机研究显示，PCI后RR增加，但在入选的多支血管病变患者中，随访长达5年时，PCI与CABG的结果在其他方面相似。尚无10年的数据。
分析纳入了波兰SOS研究中随机分组的100例患者。
患者在基线人口统计学和血管造影特征方面匹配良好。在9.6±0.85年的观察期内，两组在生存率、CCS和LVEF方面无显著差异。PCI后RR增加；分别为21例（42%）和9例（18%），P<0.05。因此，PCI后的MACCE也显著更高；分别为36例（72%）和28例（56%），P<0.05。RR增加主要发生在第一年，随着时间推移逐渐减少，从第5年到第10年，PCI后的RR在数值上更少；分别为2例（4%）和7例（14%），P=无显著性差异。
这些发现表明，技术上适合支架辅助PCI或CABG的多支血管冠状动脉疾病患者，在死亡率、心绞痛分级、LVEF和MACCE方面，除RR外，10年结局非常相似。PCI后RR增加主要发生在早期，在第5 - 10年，PCI后的RR在数值上更低。这突出了随机试验进行长期随访的必要性。
