Institute of Sociology and Demography, University of Rostock, Ulmenstraße 69, 18057, Rostock, Germany.
German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1/99, 53127, Bonn, Germany.
J Cardiothorac Surg. 2022 Oct 1;17(1):246. doi: 10.1186/s13019-022-02014-2.
Due to demographic aging, the prevalence of coronary artery disease (CAD) is expected to increase in the future, resulting in a growing demand for stent and bypass interventions. This study aims to investigate the mortality risk of patients following conventional coronary artery bypass grafting (CABG) or endovascular procedure by the implantation of bare-metal stents (BMS) or drug-eluting stents (DES).
Based on a random sample of 250,000 members of Germany's largest health insurance 'Allgemeine Ortskrankenkassen' (AOK) from 2004 to 2015, incident CAD patients were analyzed by Cox Proportional-Hazard models. Risk adjustment was made for sex, age, other cardiac diseases, non-cardiovascular comorbidities and years since intervention. Due to later admission of DES and thus a shorter observation time, mortality was examined for 3 years since the intervention.
BMS represented the most frequent procedure (48%). We found similar proportions of CABG (19%) and DES interventions (23%). After risk adjustment, the models showed a 21% (p = 0.004) lower mortality risk of patients with DES and also a 21% (p = 0.002) lower mortality risk of CABG patients compared to persons with BMS.
Based on a large-scale dataset, our study demonstrated survival advantages of CABG and DES interventions over BMS, with no differences between the DES and CABG groups. The results help to assess the risks of coronary interventions. Aspects of quality of life, severity of postoperative physical limitations, duration of rehabilitation, patients' preferences, and aspects of cost-effectiveness for hospitals and society should be further considered.
由于人口老龄化，未来冠心病（CAD）的患病率预计将增加，因此对支架和旁路介入的需求也将不断增长。本研究旨在通过植入裸金属支架（BMS）或药物洗脱支架（DES），调查接受传统冠状动脉旁路移植术（CABG）或血管内治疗的患者的死亡率风险。
本研究基于德国最大的健康保险公司“Allgemeine Ortskrankenkassen”（AOK）在 2004 年至 2015 年期间的 25 万名随机抽样成员，通过 Cox 比例风险模型对确诊 CAD 的患者进行分析。性别、年龄、其他心脏疾病、非心血管合并症和介入后时间等因素进行风险调整。由于 DES 入院较晚，因此观察时间较短，故仅在介入后 3 年内检查死亡率。
BMS 是最常见的治疗方法（48%）。我们发现 CABG（19%）和 DES 干预（23%）的比例相似。在风险调整后，模型显示，DES 组的死亡率降低了 21%（p=0.004），CABG 组的死亡率也降低了 21%（p=0.002），与 BMS 组相比。
基于大型数据集，本研究表明，与 BMS 相比，CABG 和 DES 干预具有生存优势，DES 和 CABG 组之间无差异。研究结果有助于评估冠状动脉介入治疗的风险。还应进一步考虑生活质量、术后身体限制严重程度、康复时间、患者偏好和医院及社会成本效益等方面。
