Rodriguez A, Boullon F, Perez-Baliño N, Paviotti C, Liprandi M I, Palacios I F
Cardiac Unit, Anchorena Hospital, Buenos Aires, Argentina.
J Am Coll Cardiol. 1993 Oct;22(4):1060-7. doi: 10.1016/0735-1097(93)90416-x.
This study was designed to compare freedom from combined cardiac events (death, angina, myocardial infarction) at 1-, 3- and 5-year follow-up in patients with multivessel disease randomized to either percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery.
Percutaneous transluminal coronary angioplasty has been an effective approach in patients with coronary artery disease, but its role in patients with multivessel coronary artery disease is still controversial.
One-hundred twenty-seven patients with multivessel disease and lesions suitable for either form of therapy were randomized to either coronary artery bypass grafting (n = 64) or coronary angioplasty (n = 63). In this study we report the immediate results and freedom from combined cardiac events at 1-year follow-up.
Demographic, clinical and angiographic characteristics were similar in both groups. There were no differences in in-hospital deaths, frequency of periprocedure myocardial infarction or need for emergency revascularization procedures between the two groups. At 1-year follow-up, there were no differences in mortality or in the incidence of myocardial infarction between the groups. However, patients treated with coronary artery bypass grafting were more frequently free of angina, reinterventions and combined cardiac events than were patients treated with coronary angioplasty (83.5% vs. 63.7%, p < 0.005). In-hospital cost and cumulative cost at 1-year follow-up were greater for the coronary artery bypass grafting than for the coronary angioplasty group.
No significant differences were found in major in-hospital complications between patients treated with coronary artery bypass grafting or coronary angioplasty. Although at 1-year follow-up there were no differences in survival and freedom from myocardial infarction, patients in the coronary artery bypass grafting group were more frequently free from angina, reinterventions and combined events than were patients in the coronary angioplasty group.
本研究旨在比较多支血管病变患者随机接受经皮腔内冠状动脉成形术或冠状动脉旁路移植术后1年、3年和5年随访时联合心脏事件（死亡、心绞痛、心肌梗死）的发生率。
经皮腔内冠状动脉成形术一直是冠心病患者的有效治疗方法，但其在多支冠状动脉病变患者中的作用仍存在争议。
127例多支血管病变且病变适合两种治疗方式之一的患者被随机分为冠状动脉旁路移植术组（n = 64）或冠状动脉成形术组（n = 63）。在本研究中，我们报告了即刻结果以及1年随访时联合心脏事件的发生率。
两组的人口统计学、临床和血管造影特征相似。两组在住院死亡、围手术期心肌梗死发生率或急诊血运重建手术需求方面无差异。在1年随访时，两组在死亡率或心肌梗死发生率方面无差异。然而，冠状动脉旁路移植术治疗的患者比冠状动脉成形术治疗的患者更频繁地无心绞痛、再次干预和联合心脏事件（83.5%对63.7%，p < 0.005）。冠状动脉旁路移植术组的住院费用和1年随访时的累积费用高于冠状动脉成形术组。
冠状动脉旁路移植术或冠状动脉成形术治疗的患者在主要住院并发症方面未发现显著差异。尽管在1年随访时生存率和无心肌梗死发生率无差异，但冠状动脉旁路移植术组的患者比冠状动脉成形术组的患者更频繁地无心绞痛、再次干预和联合事件。
