冠状动脉搭桥手术与药物洗脱支架植入术治疗左主干或多支冠状动脉疾病高手术风险患者的比较

Coronary artery bypass graft surgery versus drug-eluting stent implantation for high-surgical-risk patients with left main or multivessel coronary artery disease.

作者信息

Chang Mineok, Lee Cheol Whan, Ahn Jung-Min, Cavalcante Rafael, Sotomi Yohei, Onuma Yoshinobu, Park Duk-Woo, Kang Soo-Jin, Lee Seung-Whan, Kim Young-Hak, Park Seong-Wook, Serruys Patrick W, Park Seung-Jung

机构信息

Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

Department of Cardiology, Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.

出版信息

Eur J Cardiothorac Surg. 2017 May 1;51(5):943-949. doi: 10.1093/ejcts/ezw370.

DOI:10.1093/ejcts/ezw370

PMID:28329291

Abstract

OBJECTIVES

There are limited data comparing long-term outcomes of coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with high surgical risk. We evaluated 5-year outcomes following CABG versus PCI with DES in 598 patients with left main or multivessel coronary artery disease (CAD) and a high surgical risk [EuroSCORE (European system for cardiac operative risk evaluation) ≥ 6].

METHODS

Databases were merged from the BEST, PRECOMBAT and SYNTAX trials. The primary outcome was a major adverse cardio-cerebral event (MACCE), defined as the composite of all-cause death, myocardial infarction, stroke or repeat revascularization.

RESULTS

During 5-year follow-up, the rates of MACCE were 29.4% in the CABG group and 43.8% in the PCI group [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.49 - 0.84; P = 0.001]. The MACCE was significantly better with CABG than with PCI in patients with high and intermediate SYNTAX scores (34.9% vs 46.3%, P = 0.039, and 29.7% vs 47.6%, P = 0.010, respectively), but comparable between the two groups in those with low SYNTAX scores. The rates of all-cause death and stroke were similar between the two groups. However, CABG was associated with fewer myocardial infarctions (HR, 0.50; 95% CI, 0.27 - 0.93; P = 0.027) and repeat revascularizations (HR, 0.32; 95% CI, 0.20 - 0.52; P < 0.001).

CONCLUSIONS

Among high surgical risk patients with left main or multivessel CAD, CABG compared to PCI with DES was associated with a lower rate of MACCE.

摘要

目的

在手术风险高的患者中，比较冠状动脉旁路移植术（CABG）和药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）的长期疗效的数据有限。我们评估了598例左主干或多支冠状动脉疾病（CAD）且手术风险高[欧洲心脏手术风险评估系统（EuroSCORE）≥6]的患者接受CABG与DES-PCI治疗后的5年疗效。

方法

合并BEST、PRECOMBAT和SYNTAX试验的数据库。主要结局是主要不良心脑血管事件（MACCE），定义为全因死亡、心肌梗死、中风或再次血运重建的复合事件。

结果

在5年随访期间，CABG组的MACCE发生率为29.4%，PCI组为43.8%[风险比（HR），0.64；95%置信区间（CI），0.49 - 0.84；P = 0.001]。在SYNTAX评分高和中等的患者中，CABG的MACCE明显优于PCI（分别为34.9%对46.3%，P = 0.039；29.7%对47.6%，P = 0.010），但在SYNTAX评分低的患者中两组相当。两组的全因死亡和中风发生率相似。然而，CABG与较少的心肌梗死（HR，0.50；95%CI，0.27 - 0.93；P = 0.027）和再次血运重建相关（HR，0.32；95%CI，0.20 - 0.52；P < 0.001）。