在真实世界中患有多支冠状动脉疾病（包括左主干疾病）的患者中，冠状动脉旁路移植术相较于新一代支架的经皮冠状动脉介入治疗可带来中期生存获益：一项回顾性分析纳入了 6383 例患者。
Coronary artery bypass confers intermediate-term survival benefit over percutaneous coronary intervention with new-generation stents in real-world patients with multivessel coronary artery disease, including left main disease: a retrospective analysis of 6383 patients.
机构信息
Department of Interventional Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Greater London, UK.
Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, South Kensington, London, UK.
出版信息
Eur J Cardiothorac Surg. 2019 Nov 1;56(5):911-918. doi: 10.1093/ejcts/ezz142.
OBJECTIVES
The intermediate-term all-cause mortality rate of real-world patients with multivessel disease (MVD) treated with percutaneous coronary intervention (PCI) with new-generation drug-eluting stents or coronary artery bypass grafting (CABG) remains unknown. We sought to compare the intermediate-term all-cause mortality rates of real-world patients with MVD including left main stem disease, treated with CABG or PCI.
METHODS
All consecutive all-comer patients with MVD undergoing CABG or PCI with second/third generation drug-eluting stents from 2007 to 2015 in Harefield Hospital, UK were included in this study. The revascularization modality was based on heart team discussions. Primary outcome was all-cause mortality. Mean follow-up of the study was 3.3 years. Cox regression analysis and propensity matching were used.
RESULTS
Of 6383 patients with MVD, 4230 underwent CABG, whereas 2153 had PCI with new-generation stents. In the CABG group, the mean age was 66.4 ± 10 years, whereas in the PCI group it was 65.3 ± 12.1 years (P < 0.001). Fewer female patients with MVD were treated with CABG than were treated with PCI (18.5% vs 20.5%; P = 0.026). There was a higher 5-year estimated survival rate among patients having CABG (88% vs 78.3%; Plog-rank < 0.001). The adjusted hazard ratio (HR) for PCI over CABG was 1.74 [95% confidence interval (CI) 1.41-2.16; P < 0.001]. A total of 653 patients having CABG and 653 having PCI were included in the propensity-matched groups. At mean follow-up, PCI was associated with a higher adjusted HR for all-cause mortality (2.18, 95% CI 1.54-3.1; P < 0.001).
CONCLUSIONS
In this contemporary cohort of real-world patients with MVD, CABG was associated with increased intermediate-term survival compared to PCI with new-generation drug-eluting stents.
目的
使用新一代药物洗脱支架行经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）治疗多支血管病变（MVD）的真实世界患者的中期全因死亡率尚不清楚。我们旨在比较包括左主干疾病在内的 MVD 真实世界患者接受 CABG 或 PCI 的中期全因死亡率。
方法
本研究纳入了 2007 年至 2015 年期间在英国 Harefield 医院接受 CABG 或使用第二代/第三代药物洗脱支架进行 PCI 的所有 MVD 全患者。血运重建方式基于心脏团队的讨论。主要结局为全因死亡率。本研究的平均随访时间为 3.3 年。采用 Cox 回归分析和倾向评分匹配。
结果
在 6383 例 MVD 患者中，4230 例行 CABG，2153 例行新一代支架 PCI。CABG 组的平均年龄为 66.4±10 岁，而 PCI 组为 65.3±12.1 岁（P<0.001）。MVD 女性患者接受 CABG 治疗的比例低于接受 PCI 治疗的患者（18.5%比 20.5%；P=0.026）。接受 CABG 治疗的患者 5 年估计生存率更高（88%比 78.3%；log-rank P<0.001）。PCI 与 CABG 的调整后的危险比（HR）为 1.74（95%置信区间 1.41-2.16；P<0.001）。在倾向评分匹配的 CABG 组和 PCI 组中，分别纳入了 653 例患者。在平均随访期间，与 CABG 相比，PCI 与全因死亡率的调整后 HR 更高（2.18，95%置信区间 1.54-3.1；P<0.001）。
结论
在本项真实世界的 MVD 当代队列研究中，与使用新一代药物洗脱支架的 PCI 相比，CABG 与中期生存率的提高相关。
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