University at Albany, State University of New York, Albany, New York.
University at Albany, State University of New York, Albany, New York.
J Am Coll Cardiol. 2014 Dec 30;64(25):2717-26. doi: 10.1016/j.jacc.2014.09.074.
Few recent studies have compared the outcomes of coronary artery bypass graft (CABG) surgery with percutaneous coronary interventions (PCIs) in patients with isolated (single vessel) proximal left anterior descending (PLAD) coronary artery disease in the era of drug-eluting stents (DES).
The goal of this study was to compare outcomes in patients with PLAD who underwent CABG and PCI with DES.
New York's Percutaneous Coronary Interventions Reporting System was used to identify and track all patients who underwent CABG surgery and received DES for isolated PLAD disease between January 1, 2008 and December 31, 2010, and who were followed-up through December 31, 2011. A total of 5,340 of 6,064 (88%) patients received DES. Patients were matched to vital statistics data to obtain mortality after discharge and matched to New York's administrative data to obtain readmissions for myocardial infarction (MI) and stroke. To minimize selection bias, patients were propensity matched into 715 CABG and/or DES pairs, and 3 outcome measures were compared across the pairs.
Kaplan-Meier estimates for CABG and DES did not significantly differ for mortality or mortality, MI, and/or stroke, but repeat revascularization rates were lower for CABG (7.09% vs. 12.98%; p = 0.0007). After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year mortality rates (CABG and/or DES adjusted hazard ratio (AHR): 1.14; 95% confidence interval [CI]: 0.70 to 1.85) or mortality, MI, and/or stroke rates (AHR: 1.15; 95% CI: 0.76 to 1.73), and the repeat revascularization rate remained significantly lower for CABG patients (AHR: 0.54; 95% CI: 0.36 to 0.81).
Despite the higher rating in current guidelines of CABG (Class IIa vs. Class IIb) for patients with isolated PLAD disease, there were no differences in mortality or mortality, MI, and/or stroke, although CABG patients had significantly lower repeat revascularization rates.
在药物洗脱支架（DES）时代，很少有研究比较孤立性（单支血管）左前降支（PLAD）近端冠状动脉疾病患者行冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）的结局。
本研究旨在比较接受 CABG 与 DES 治疗的 PLAD 患者的结局。
利用纽约经皮冠状动脉介入治疗报告系统，识别并跟踪 2008 年 1 月 1 日至 2010 年 12 月 31 日期间接受 CABG 手术并接受 DES 治疗孤立性 PLAD 病变的所有患者，并随访至 2011 年 12 月 31 日。6064 例患者中有 5340 例（88%）接受 DES 治疗。患者与生命统计数据相匹配以获得出院后的死亡率，并与纽约行政数据相匹配以获得心肌梗死（MI）和中风的再入院率。为尽量减少选择偏倚，将患者按倾向评分匹配为 715 对 CABG 和/或 DES，并比较了这 715 对患者的 3 项结局指标。
Kaplan-Meier 估计，CABG 和 DES 在死亡率或死亡率、MI 和/或卒中和再次血运重建率方面无显著差异，但 CABG 再次血运重建率较低（7.09% vs. 12.98%；p=0.0007）。在进一步使用 Cox 比例风险模型进行调整后，3 年死亡率（CABG 和/或 DES 校正后的危险比（AHR）：1.14；95%置信区间[CI]：0.70 至 1.85）或死亡率、MI 和/或卒中和再次血运重建率（AHR：1.15；95%CI：0.76 至 1.73）均无显著差异，CABG 患者的再次血运重建率仍显著较低（AHR：0.54；95%CI：0.36 至 0.81）。
尽管孤立性 PLAD 疾病患者的 CABG （Ⅱa 类 vs. Ⅱb 类）在当前指南中的评分较高，但死亡率或死亡率、MI 和/或卒中和再次血运重建率无差异，尽管 CABG 患者的再次血运重建率明显较低。
