Department of Public Health Sciences, Penn State Hershey College of Medicine, Hershey, Pennsylvania 17033, USA.
Ann Thorac Surg. 2011 Dec;92(6):2132-8. doi: 10.1016/j.athoracsur.2011.06.061. Epub 2011 Oct 19.
There is little information on relative survival with follow-up longer than 5 years in patients undergoing coronary artery bypass grafting (CABG) and patients undergoing percutaneous coronary intervention (PCI) with stenting. This study tested the hypothesis that CABG is associated with a lower risk of long-term (8-year) mortality than is stenting with bare-metal stents for multivessel coronary disease.
We identified 18,359 patients with multivessel disease who underwent isolated CABG and 13,377 patients who received bare-metal stenting in 1999 to 2000 in New York and followed their vital status through 2007 using the National Death Index (NDI). We matched CABG and stent patients on the number of diseased coronary vessels, proximal left anterior descending (LAD) artery disease, and propensity of undergoing CABG based on numerous patient characteristics and compared survival after the 2 procedures.
In the 7,235 pairs of matched patients, the overall 8-year survival rates were 78.0% for CABG and 71.2% for stenting (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.64 to 0.74; p < 0.001). For anatomic groups classified by the number of diseased vessels and proximal LAD involvement, the HRs ranged from 0.53 (p < 0.001) for patients with 3-vessel disease involving proximal LAD artery disease to 0.78 (p = 0.05) for patients with 2-vessel disease but no disease in the LAD artery. A lower risk of death after CABG was observed in all subgroups stratified by a number of baseline risk factors.
Coronary artery bypass grafting is associated with a lower risk of death than is stenting with bare metal stents for multivessel coronary disease.
在接受冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）加支架治疗的患者中，随访时间超过 5 年的相对生存率信息较少。本研究检验了这样一个假设，即与裸金属支架置入术治疗多支血管病变相比，CABG 与长期（8 年）死亡率降低相关。
我们在 1999 年至 2000 年期间确定了 18359 例接受单纯 CABG 治疗和 13377 例接受裸金属支架置入术治疗的多支血管病变患者，并通过国家死亡指数（NDI）跟踪其生命状态至 2007 年。我们根据许多患者特征，按病变冠状动脉数量、左前降支（LAD）近端疾病和 CABG 倾向性，对 CABG 与支架患者进行了匹配，并比较了两种治疗方法后的生存情况。
在 7235 对匹配患者中，CABG 的总体 8 年生存率为 78.0%，支架置入术为 71.2%（风险比[HR]，0.68；95%置信区间[CI]，0.64 至 0.74；p < 0.001）。对于根据病变血管数量和 LAD 近端受累情况进行分类的解剖学亚组，HR 范围从涉及 LAD 近端病变的 3 支血管病变患者的 0.53（p < 0.001）到 2 支血管病变但 LAD 无病变患者的 0.78（p = 0.05）。在按多种基线风险因素分层的所有亚组中，CABG 后死亡风险均较低。
与裸金属支架置入术治疗多支血管病变相比，冠状动脉旁路移植术与较低的死亡风险相关。
