Department of Cardiology, Capital University of Medical Sciences, Beijing, China.
Yonsei Med J. 2011 Nov;52(6):923-32. doi: 10.3349/ymj.2011.52.6.923.
Several studies have compared the effects of coronary stenting and coronary- artery bypass grafting (CABG) on left main coronary artery (LMCA) disease. However, there are limited data on the long-term outcomes of these two interventions in diabetic patients.
We evaluated 56 patients with LMCA stenosis who underwent drug-eluting stent (DES) implantation and 116 patients who underwent CABG in a single hospital in China between January 2004 and December 2006. We compared long-term major adverse cardiac events (death; a "serious outcome" composite of death, myocardial infarction, or stroke; and target-vessel revascularization).
In-hospital (30-day) mortality was 0% for the DES group and 3.4% for the CABG group (p=0.31). There was no difference between the two groups in terms of risk of death [hazard ratio for stenting group, 0.49; 95% confidence interval (CI), 0.13-1.63; p=0.55] or risk of serious outcome (hazard ratio for DES group, 1.11; 95% CI, 0.39-1.45; p=0.47). The target-vessel revascularization rate was higher in the DES group than in the CABG group (hazard ratio, 3.67; 95% CI, 1.24-11.06; p=0.018).
In this cohort of diabetic patients with LMCA stenosis, there was no difference in composite endpoints between patients receiving DESs and those undergoing CABG. However, stenting was associated with higher rates of target-vessel revascularization than CABG. DES implantation in diabetic patients with LMCA disease was found to be at least as safe as CABG.
几项研究比较了冠状动脉支架置入术和冠状动脉旁路移植术（CABG）对左主干冠状动脉（LMCA）疾病的影响。然而，关于这两种干预措施在糖尿病患者中的长期结果的数据有限。
我们评估了 2004 年 1 月至 2006 年 12 月期间在中国一家医院接受药物洗脱支架（DES）植入术的 56 例 LMCA 狭窄患者和接受 CABG 的 116 例患者。我们比较了长期主要不良心脏事件（死亡；死亡、心肌梗死或中风的“严重结局”综合；以及靶血管血运重建）。
DES 组住院（30 天）死亡率为 0%，CABG 组为 3.4%（p=0.31）。两组在死亡风险方面没有差异[支架组的危险比为 0.49；95%置信区间（CI）为 0.13-1.63；p=0.55]或严重结局风险（DES 组的危险比为 1.11；95%CI 为 0.39-1.45；p=0.47）。DES 组的靶血管血运重建率高于 CABG 组（危险比，3.67；95%CI，1.24-11.06；p=0.018）。
在本队列中，糖尿病合并 LMCA 狭窄的患者，接受 DES 和 CABG 的患者复合终点无差异。然而，支架置入与靶血管血运重建的发生率高于 CABG。在患有 LMCA 疾病的糖尿病患者中，DES 植入术的安全性至少与 CABG 相同。
