Chang Mineok, Lee Cheol Whan, Ahn Jung-Min, Cavalcante Rafael, Sotomi Yohei, Onuma Yoshinobu, Zeng Yaping, Park Duk-Woo, Kang Soo-Jin, Lee Seung-Whan, Kim Young-Hak, Park Seong-Wook, Serruys Patrick W, Park Seung-Jung
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 2016 Jul 1;118(1):17-22. doi: 10.1016/j.amjcard.2016.04.009. Epub 2016 Apr 21.
Patients with previous myocardial infarction (MI) have a high risk of recurrence. Little is known about the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with a previous MI and left main or multivessel coronary artery disease (CAD). We compared long-term outcomes of these 2 strategies in 672 patients with previous MI and left main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n = 323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was analyzed, and the primary outcome was a composite of death from any causes, MI, or stroke. Baseline characteristics were similar between the 2 groups. The median follow-up duration was 59.8 months. The rate of the primary outcome was significantly lower with CABG than PCI (hazard ratio [HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p <0.001). The benefit of CABG over PCI was consistent across all major subgroups. The individual risks of death from any causes or stroke were comparable between the 2 groups. Conversely, the rate of repeat revascularization was significantly lower with CABG than PCI (HR 0.34, 95% CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous MI and left main or multivessel CAD, compared to PCI with DES, CABG significantly reduces the risk of death from any causes, MI, or stroke.
既往有心肌梗死（MI）的患者复发风险很高。对于既往有MI且患有左主干或多支冠状动脉疾病（CAD）的患者，冠状动脉旁路移植术（CABG）与药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）的有效性鲜为人知。我们比较了672例既往有MI且患有左主干或多支CAD并接受CABG（n = 349）或DES PCI（n = 323）的患者这两种策略的长期结局。分析了来自BEST、PRECOMBAT和SYNTAX试验的汇总数据库，主要结局是任何原因导致的死亡、MI或中风的复合结局。两组的基线特征相似。中位随访时间为59.8个月。CABG组主要结局的发生率显著低于PCI组（风险比[HR] 0.59，95% CI 0.42至0.82；p = 0.002）。这种差异是由MI发生率的显著降低所驱动的（HR 0.29，95% CI 0.16至0.55，p <0.001）。CABG优于PCI的益处在所有主要亚组中均一致。两组之间任何原因导致的死亡或中风的个体风险相当。相反，CABG组再次血运重建的发生率显著低于PCI组（HR 0.34，95% CI 0.22至0.51，p <0.001）。总之，在既往有MI且患有左主干或多支CAD的患者中，与DES PCI相比，CABG显著降低了任何原因导致的死亡、MI或中风的风险。
