Ohlow Marc-Alexander, Farah Ahmed, Kuntze Thomas, Lauer Bernward
Department of Cardiology, Zentralklinik, Bad Berka, Germany.
Medizinische Klinik III, Klinikum Westfalen, Dortmund, Germany.
Int J Clin Pract. 2018 Apr;72(4):e13056. doi: 10.1111/ijcp.13056. Epub 2018 Jan 9.
The decision for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with multi-vessel coronary artery disease (mCAD) is currently made by a heart-team approach. Patients' preference is less well investigated.
All consecutive patients with prior CABG and at least 2 PCI procedures were interviewed whether they would elect bypass surgery or staged PCI in case of a hypothetical scenario in which they had mCAD and CABG or PCI will equally improve symptoms and survival.
A total 213 patients were surveyed. About 21 (10%) patients had multiple CABG, and mean number of PCI per patient was 4.0 ± 2.7. Complications during CABG were reported in 19.7% and in 14% after PCI, respectively. About 15% experienced complications after both CABG and PCI, and 51% had no complications at all. Mean symptom-free period was 5.2 (following CABG) vs 1.8 years (following PCI); P<.001. Duration of recovery was significant shorter after PCI (mean 9.2 ± 1.2 vs 136.4 ± 57.9 days; P<.01). Based on their personal experience with both procedures, 15% of the participants elected CABG in the hypothetical scenario and 67% choose staged PCI, 18% were equally happy with either. More participants preferred PCI when age was ≥70, complications following CABG occurred, and when undergoing CABG first. Gender, number of CABG or PCI procedures per patient, and complications following PCI did not affect participants' preference.
In our hypothetical scenario, the majority of participants preferred staged PCI over CABG. Preferences were related to age, complications following CABG, and whether CABG was performed first.
目前，多支冠状动脉疾病（mCAD）患者的冠状动脉旁路移植术（CABG）或经皮冠状动脉介入治疗（PCI）决策是通过心脏团队方法做出的。对患者偏好的研究较少。
对所有既往接受过CABG且至少接受过2次PCI手术的连续患者进行访谈，询问在假设他们患有mCAD且CABG或PCI能同等程度改善症状和生存的情况下，他们会选择搭桥手术还是分期PCI。
共调查了213例患者。约21例（10%）患者接受过多次CABG，每位患者的PCI平均次数为4.0±2.7次。CABG期间的并发症发生率分别为19.7%，PCI术后为14%。约15%的患者在CABG和PCI后均出现并发症，51%的患者根本没有并发症。无症状期平均为5.2年（CABG后）对1.8年（PCI后）；P<0.001。PCI后的恢复时间明显更短（平均9.2±1.2天对136.4±57.9天；P<0.01）。基于他们对这两种手术的个人经验，15%的参与者在假设情况下选择CABG, 67%选择分期PCI，18%对两者同样满意。当年龄≥70岁、CABG后出现并发症以及首次接受CABG时，更多参与者更喜欢PCI。性别、每位患者的CABG或PCI手术次数以及PCI后的并发症不影响参与者的偏好。
在我们的假设情况下，大多数参与者更喜欢分期PCI而非CABG。偏好与年龄、CABG后的并发症以及是否首先进行CABG有关。
