Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
J Am Coll Cardiol. 2016 Jul 5;68(1):29-36. doi: 10.1016/j.jacc.2016.04.034.
In diabetic patients with multivessel coronary artery disease (CAD), the survival difference between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) favors CABG. However, there are few data on the mortality difference between the 2 strategies in nondiabetic patients.
This study performed a patient-level meta-analysis to compare the effect of CABG versus PCI with drug-eluting stents on long-term mortality in 1,275 nondiabetic patients with multivessel CAD.
Individual patient data from the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) and the BEST (Randomized Comparison of Coronary Artery Bypass Surgery and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease) trials were pooled. The primary outcome was death from any cause.
The median follow-up time was 61 months (interquartile range: 50 months to 62 months). The risk of death from any cause was significantly lower in the CABG group than in the PCI group (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.98; p = 0.039). A similar finding was observed for the risk of death from cardiac causes. The superiority of CABG over PCI was consistent across the major clinical subgroups. Likewise, the rate of myocardial infarction was remarkably lower after CABG than after PCI (HR: 0.40; 95% CI: 0.24 to 0.65; p < 0.001). However, the rate of stroke was not different between the 2 groups (HR: 1.13; 95% CI: 0.59 to 2.17; p = 0.714). The need for repeat revascularization was significantly lower in the CABG group than in the PCI group (HR: 0.55; 95% CI: 0.40 to 0.75; p < 0.001).
CABG, as compared with PCI with drug-eluting stents, significantly reduced the long-term risk of mortality in nondiabetic patients with multivessel CAD.
在患有多支血管冠状动脉疾病（CAD）的糖尿病患者中，冠状动脉旁路移植术（CABG）与经皮冠状动脉介入治疗（PCI）的生存差异有利于 CABG。然而，关于非糖尿病患者中这两种策略的死亡率差异的数据很少。
本研究进行了一项患者水平的荟萃分析，以比较在 1275 例多支血管 CAD 的非糖尿病患者中，CABG 与药物洗脱支架 PCI 治疗对长期死亡率的影响。
从 SYNTAX（紫杉醇与心脏手术的协同作用）和 BEST（多支血管冠状动脉疾病患者冠状动脉旁路移植术与依维莫司洗脱支架置入的随机比较）试验中汇总个体患者数据。主要结局是任何原因导致的死亡。
中位随访时间为 61 个月（四分位距：50 个月至 62 个月）。CABG 组的任何原因死亡率显著低于 PCI 组（风险比 [HR]：0.65；95%置信区间 [CI]：0.43 至 0.98；p = 0.039）。对于心脏原因导致的死亡风险也观察到类似的发现。CABG 优于 PCI 的优势在主要临床亚组中是一致的。同样，CABG 后心肌梗死的发生率明显低于 PCI（HR：0.40；95%CI：0.24 至 0.65；p < 0.001）。然而，两组之间的卒中发生率没有差异（HR：1.13；95%CI：0.59 至 2.17；p = 0.714）。CABG 组再次血运重建的需要明显低于 PCI 组（HR：0.55；95%CI：0.40 至 0.75；p < 0.001）。
与药物洗脱支架 PCI 相比，CABG 显著降低了多支血管 CAD 的非糖尿病患者的长期死亡率风险。
