Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Ann Thorac Surg. 2013 Dec;96(6):2038-44. doi: 10.1016/j.athoracsur.2013.06.052. Epub 2013 Aug 20.
The efficacy of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in patients with coronary artery disease has been well defined by randomized controlled trials. However, patients with severe left ventricular dysfunction (ejection fraction <35%) were underrepresented in these trials, and management of these complex patients remains unclear. The purpose of this study was to compare the outcomes of patients with coronary artery disease and left ventricular dysfunction undergoing CABG versus PCI.
The Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH), a clinical data collection and outcome monitoring initiative for the province of Alberta, Canada, was used to identify 2925 patients with coronary artery disease and left ventricular dysfunction undergoing CABG (n = 1,326) or PCI (n = 1,599) between 1995 and 2008. Patients were propensity matched to obtain comparable subgroups among left ventricular dysfunction patients.
Cox proportional hazard analysis of the propensity-matched subgroups identified that CABG was significantly associated with lower rates of repeat revascularization and better survival compared with PCI at 1, 5, 10, and 15 years. Other significant independent predictors of poor long-term survival included age, renal failure, heart failure, diabetes mellitus, peripheral vascular disease, prior myocardial infarction, left main coronary artery disease, and prior CABG.
For patients with coronary artery disease and left ventricular dysfunction, CABG was associated with lower rates of repeat revascularization and improved survival over PCI, after adjustment for baseline risk profile differences. Further research exploring the factors leading to use of a particular revascularization modality in this patient population is required.
冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）治疗冠心病的疗效已在随机对照试验中得到明确界定。然而，这些试验中严重左心室功能障碍（射血分数<35%）患者代表性不足，这些复杂患者的治疗仍不明确。本研究旨在比较行 CABG 与 PCI 的冠心病合并左心室功能障碍患者的结局。
利用加拿大艾伯塔省冠心病结局评估省级项目（APPROACH），这是一个用于艾伯塔省的临床数据收集和结局监测计划，确定了 1995 年至 2008 年间行 CABG（n=1326）或 PCI（n=1599）治疗的 2925 例冠心病合并左心室功能障碍患者。通过倾向评分匹配获得可比的左心室功能障碍患者亚组。
倾向评分匹配亚组的 Cox 比例风险分析表明，CABG 与 PCI 相比，1、5、10 和 15 年时再次血运重建率较低，生存率较高。其他与长期生存不良显著相关的独立预测因素包括年龄、肾衰竭、心力衰竭、糖尿病、外周血管疾病、既往心肌梗死、左主干冠状动脉疾病和既往 CABG。
对于冠心病合并左心室功能障碍的患者，在调整基线风险特征差异后，CABG 与再次血运重建率较低和生存率提高相关。需要进一步研究探索导致该患者人群采用特定血运重建方式的因素。
