Borges Jorge Chiquie, Lopes Neuza, Soares Paulo R, Góis Aécio F T, Stolf Noedir A, Oliveira Sergio A, Hueb Whady A, Ramires Jose A F
Heart Institute (InCor), University of São Paulo Medical of School, São Paulo, Brazil.
J Cardiothorac Surg. 2010 Oct 26;5:91. doi: 10.1186/1749-8090-5-91.
Progression of atherosclerosis in coronary artery disease is observed through consecutive angiograms. Prognosis of this progression in patients randomized to different treatments has not been established. This study compared progression of coronary artery disease in native coronary arteries in patients undergoing surgery, angioplasty, or medical treatment.
Patients (611) with stable multivessel coronary artery disease and preserved ventricular function were randomly assigned to CABG, PCI, or medical treatment alone (MT). After 5-year follow-up, 392 patients (64%) underwent new angiography. Progression was considered a new stenosis of ≥ 50% in an arterial segment previously considered normal or an increased grade of previous stenosis > 20% in nontreated vessels.
Of the 392 patients, 136 underwent CABG, 146 PCI, and 110 MT. Baseline characteristics were similar among treatment groups, except for more smokers and statin users in the MT group, more hypertensives and lower LDL-cholesterol levels in the CABG group, and more angina in the PCI group at study entry. Analysis showed greater progression in at least one native vessel in PCI patients (84%) compared with CABG (57%) and MT (74%) patients (p < 0.001). LAD coronary territory had higher progression compared with LCX and RCA (P < 0.001). PCI treatment, hypertension, male sex, and previous MI were independent risk factors for progression. No statistical difference existed between coronary events and the development of progression.
The angioplasty treatment conferred greater progression in native coronary arteries, especially in the left anterior descending territories and treated vessels. The progression was independently associated with hypertension, male sex, and previous myocardial infarction.
通过连续血管造影观察冠状动脉疾病中动脉粥样硬化的进展。随机接受不同治疗的患者中这种进展的预后尚未确定。本研究比较了接受手术、血管成形术或药物治疗的患者原生冠状动脉中冠状动脉疾病的进展情况。
将611例患有稳定多支冠状动脉疾病且心室功能保留的患者随机分配至冠状动脉旁路移植术（CABG）、经皮冠状动脉介入治疗（PCI）或单纯药物治疗（MT）。5年随访后，392例患者（64%）接受了新的血管造影。进展被定义为先前被认为正常的动脉节段出现≥50%的新狭窄，或未治疗血管中先前狭窄程度增加>20%。
在392例患者中，136例接受了CABG，146例接受了PCI，110例接受了MT。各治疗组的基线特征相似，但MT组吸烟者和他汀类药物使用者更多，CABG组高血压患者更多且低密度脂蛋白胆固醇水平更低，PCI组在研究入组时心绞痛患者更多。分析显示，PCI患者（84%）中至少一支原生血管的进展情况比CABG患者（57%）和MT患者（74%）更严重（p<0.001）。左冠状动脉前降支区域的进展比左旋支和右冠状动脉更高（P<0.001）。PCI治疗、高血压、男性以及既往心肌梗死是进展的独立危险因素。冠状动脉事件与进展的发生之间无统计学差异。
血管成形术治疗使原生冠状动脉进展更严重，尤其是在左前降支区域和治疗的血管中。进展与高血压、男性和既往心肌梗死独立相关。
