Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy.
Eur J Cardiothorac Surg. 2013 Jul;44(1):e16-24. doi: 10.1093/ejcts/ezt197. Epub 2013 Apr 28.
Most studies comparing coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) showed that fewer patients who had undergone CABG required repeat revascularizations , but no difference in survival, with the exception of some subgroups of patients. However, long-term real-world evidence on patients in whom both procedures are technically feasible is yet not available. The aim of this study was to compare 5-year rates of death, myocardial infarction (MI), target vessel revascularization (TVR) and stroke in a large cohort of patients with left main coronary artery (LMCA) or multivessel disease, treated with CABG or PCI (with or without DES) or PCI with DES only.
Two propensity score (PS)-matched cohorts of patients undergoing revascularization procedures at the regional public and private centres of Emilia-Romagna over the period July 2002-December 2008 were used to compare long-term outcomes of PCI (6246 patients) and CABG (5504 patients).
PCI was associated with higher risk of death (HR = 1.6; 95% CI 1.4-1.8, P < 0.0001), MI (HR = 3.3; 95% CI 2.7-4.0, P < 0.0001) and TVR (HR = 4.5; 95% CI 3.8-5.2, P < 0.0001) at 5 years. No significant difference was shown for stroke (HR = 1.1; 95% CI 0.9-1.4, P = 0.43). CABG benefit was more evident in the risk of death in patients with two-vessel disease plus LMCA and in those with three-vessel disease, LVEF <35%, congestive heart failure and diabetes. Adjusted comparison with PS between PCI with DES only and CABG confirmed significant differences in favour of CABG for mortality, MI and TVR rates. Competing risk analysis showed that the difference in the mortality rate was due to higher rate of MI in PCI.
In the 'real-world' setting of this study, CABG was associated with significantly lower rates of death, MI and TVR in patients with LMCA or multivessel disease, so it remains the standard of care, particularly for patients with more extensive coronary disease and diabetes.
大多数比较冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）的研究表明，接受 CABG 的患者需要再次血运重建的比例较低，但除了一些亚组患者外，生存率没有差异。然而，关于两种手术技术均可行的患者的长期真实世界证据尚不清楚。本研究的目的是比较在左主干冠状动脉（LMCA）或多支血管病变患者中，使用 CABG 或 PCI（有或无 DES）或仅 PCI 加 DES 治疗的大样本队列中，5 年死亡率、心肌梗死（MI）、靶血管血运重建（TVR）和卒中的发生率。
使用 2002 年 7 月至 2008 年 12 月期间艾米利亚-罗马涅地区公立和私立中心进行血运重建的患者的 2 个倾向评分（PS）匹配队列，比较 PCI（6246 例）和 CABG（5504 例）的长期结果。
与 PCI 相比，CABG 患者 5 年死亡率（HR=1.6；95%CI 1.4-1.8，P<0.0001）、MI（HR=3.3；95%CI 2.7-4.0，P<0.0001）和 TVR（HR=4.5；95%CI 3.8-5.2，P<0.0001）的风险更高。但在卒中方面（HR=1.1；95%CI 0.9-1.4，P=0.43）未显示出显著差异。在两血管疾病加 LMCA 和三血管疾病、左心室射血分数（LVEF）<35%、充血性心力衰竭和糖尿病患者中，CABG 的获益在死亡风险方面更为明显。与仅 PCI 加 DES 进行 PS 调整比较，证实 CABG 在死亡率、MI 和 TVR 方面具有显著优势。竞争风险分析表明，死亡率的差异是由于 PCI 中 MI 发生率较高所致。
在本研究的“真实世界”环境中，CABG 与 LMCA 或多血管疾病患者的死亡率、MI 和 TVR 发生率显著降低相关，因此它仍然是治疗的标准，特别是对于更广泛的冠状动脉疾病和糖尿病患者。
