Christiana Care Health System, Newark, DE 19718, USA.
N Engl J Med. 2012 Apr 19;366(16):1467-76. doi: 10.1056/NEJMoa1110717. Epub 2012 Mar 27.
Questions persist concerning the comparative effectiveness of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). The American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) collaborated to compare the rates of long-term survival after PCI and CABG.
We linked the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services for the years 2004 through 2008. Outcomes were compared with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment-selection bias.
Among patients 65 years of age or older who had two-vessel or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years. At 1 year, there was no significant difference in adjusted mortality between the groups (6.24% in the CABG group as compared with 6.55% in the PCI group; risk ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00). At 4 years, there was lower mortality with CABG than with PCI (16.4% vs. 20.8%; risk ratio, 0.79; 95% CI, 0.76 to 0.82). Similar results were noted in multiple subgroups and with the use of several different analytic methods. Residual confounding was assessed by means of a sensitivity analysis.
In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI. (Funded by the National Heart, Lung, and Blood Institute.).
经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的比较效果仍存在疑问。美国心脏病学院基金会（ACCF）和胸外科医师学会（STS）合作，比较了 PCI 和 CABG 后长期生存率。
我们将 ACCF 国家心血管数据注册中心和 STS 成人心脏外科学数据库与医疗保险和医疗补助服务中心的索赔数据相链接，时间范围为 2004 年至 2008 年。使用倾向评分和逆概率加权调整来比较结果，以减少治疗选择偏倚。
在年龄在 65 岁或以上、无急性心肌梗死的两血管或三血管冠状动脉疾病患者中，86244 例患者接受了 CABG，103549 例患者接受了 PCI。中位随访时间为 2.67 年。在 1 年时，两组的调整死亡率没有显著差异（CABG 组为 6.24%，PCI 组为 6.55%；风险比，0.95；95%置信区间[CI]，0.90 至 1.00）。在 4 年时，CABG 组的死亡率低于 PCI 组（16.4%比 20.8%；风险比，0.79；95%CI，0.76 至 0.82）。在多个亚组和使用几种不同的分析方法中均观察到了类似的结果。通过敏感性分析评估残留混杂。
在这项观察性研究中，我们发现，在不需要紧急治疗的多血管冠状动脉疾病的老年患者中，与接受 PCI 的患者相比，接受 CABG 的患者具有长期生存优势。（由美国国立心肺血液研究所资助）。
