Hochberg M S, Gielchinsky I, Parsonnet V, Hussain S M, Mirsky E, Fisch D
Department of Cardiovascular and Thoracic Surgery, Newark Beth Israel Medical Center, Newark, NJ 07112.
J Thorac Cardiovasc Surg. 1989 Apr;97(4):496-503.
Two hundred fifty consecutive patients treated for one or two vessel coronary artery disease with either balloon angioplasty or surgical bypass were monitored for 3 years in a study designed to determine the comparative long-term effectiveness of each treatment. The 125 patients having angioplasty were matched with the 125 patients having bypass, so that both groups had a similar number of patients with single or double vessel disease. The two groups did not significantly differ in age, male:female ratio, New York Heart Association class, or risk factors. The ejection fraction was 54 +/- 11 in the angioplasty group and 49 +/- 12 mmHg in the surgical patients (p = 0.0031). Angioplasty was deemed initially successful in 88% (110/125), unsuccessful in 10% (12/125), and in 2% (3/125) the lesion could not be crossed. Emergency bypass was performed in 10% (12/125). Four of the 125 angioplasty patients (3%) died within 30 days. Coronary artery bypass grafting was successfully performed on the matched set of surgical patients with 99% (124/125) discharged well. There was one (1%, 1/125) surgical death. The average hospital stay per patient was 4.8 +/- 3.1 days for angioplasty and 12.1 +/- 4.2 days for bypass grafting (p = 0.0000). Three-year postprocedure follow-up was obtained on 96% (236) of the 245 patients discharged alive. A second angioplasty was required in 18%, and 11 angioplasty patients subsequently required surgical bypass. Overall, 19% (23/121) of the angioplasty patients ultimately required bypass. Four late deaths occurred in the angioplasty group, which brought the early and late mortality rates to 7% (8/121). There were two late surgical deaths, which brought the combined surgical mortality to 2.5% (3/120), p = 0.1263. Patient evaluation reveals that 63% (76/121) of the angioplasty group are alive and in New York Heart Association class I or II 3 years after one or two angioplasty procedures. This figure compares with 92% (110/120) of surgical patients alive and in the same two New York Heart Association classes (p = 0.0000).
在一项旨在确定每种治疗方法长期效果比较的研究中，对250例接受单支或双支冠状动脉疾病治疗的连续患者进行了3年的监测，这些患者接受了球囊血管成形术或外科搭桥手术。接受血管成形术的125例患者与接受搭桥手术的125例患者进行了匹配，以便两组中单支或双支血管疾病的患者数量相似。两组在年龄、男女比例、纽约心脏协会分级或危险因素方面无显著差异。血管成形术组的射血分数为54±11，外科手术患者为49±12 mmHg（p = 0.0031）。血管成形术最初被认为成功的比例为88%（110/125），不成功的比例为10%（12/125），2%（3/125）的病变无法通过。10%（12/125）的患者进行了急诊搭桥手术。125例血管成形术患者中有4例（3%）在30天内死亡。与之匹配的外科手术患者进行冠状动脉搭桥术成功，99%（124/125）患者康复出院。有1例（1%，1/125）手术死亡。血管成形术患者的平均住院时间为4.8±3.1天，搭桥手术患者为12.1±4.2天（p = 0.0000）。245例存活出院患者中有96%（236例）获得了3年的术后随访。18%的患者需要再次进行血管成形术，11例血管成形术患者随后需要进行外科搭桥手术。总体而言，19%（23/121）的血管成形术患者最终需要进行搭桥手术。血管成形术组发生了4例晚期死亡，这使得早期和晚期死亡率达到7%（8/121）。有2例外科手术晚期死亡，这使得外科手术总死亡率达到2.5%（3/120），p = 0.1263。患者评估显示，血管成形术组63%（76/121）的患者在进行一次或两次血管成形术后3年仍存活，且纽约心脏协会分级为I级或II级。相比之下，外科手术患者中这一比例为92%（110/120）存活且处于相同两级纽约心脏协会分级（p = 0.0000）。
