O'Keefe J H, Allan J J, McCallister B D, McConahay D R, Vacek J L, Piehler J M, Ligon R, Hartzler G O
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri.
Am J Cardiol. 1993 Apr 15;71(11):897-901. doi: 10.1016/0002-9149(93)90903-p.
Patients with multivessel coronary artery disease and left ventricular dysfunction represent a high-risk subgroup in whom coronary artery bypass grafting has been shown to improve survival compared with that of medically treated patients. The comparative benefits and risks of coronary angioplasty and bypass surgery in this subgroup of patients are unclear. This study retrospectively analyzes 100 consecutive patients treated with bypass surgery compared with a matched, concurrent cohort of 100 treated with multivessel angioplasty. Early results favored angioplasty; a hospital stay of 12.8 days was noted in the bypass group compared with 4.3 days in the angioplasty group (p < 0.001). In-hospital mortality rates were similar in the bypass (5%) and angioplasty (3%) groups (p = NS). Stroke was observed significantly more often in the bypass group (7 vs 0%). However, late follow-up favored bypass patients; repeat revascularization procedures and late myocardial infarction occurred more frequently during follow-up in the angioplasty group. During 5-year follow-up, superior relief from disabling angina (99 vs 89%; p = 0.01) and a trend toward improved survival (76 vs 67%; p = 0.09) were observed in the bypass group as compared with the angioplasty group. Multivariate correlates of late mortality included age and incomplete revascularization, but not mode of revascularization. Thus, in patients with multivessel coronary artery disease and left ventricular dysfunction, early results favor angioplasty, whereas late follow-up favors bypass surgery. However, late survival was similar in both groups of patients who were completely revascularized.
患有多支冠状动脉疾病和左心室功能障碍的患者是一个高危亚组，研究表明，与接受药物治疗的患者相比，冠状动脉旁路移植术可提高该亚组患者的生存率。在这一亚组患者中，冠状动脉血管成形术和旁路手术的相对获益和风险尚不清楚。本研究回顾性分析了连续100例行旁路手术的患者，并与同期匹配的100例行多支血管成形术的队列进行比较。早期结果显示血管成形术更具优势；旁路手术组的住院时间为12.8天，而血管成形术组为4.3天（p<0.001）。旁路手术组（5%）和血管成形术组（3%）的住院死亡率相似（p=无显著性差异）。旁路手术组中风的发生率明显更高（7%对0%）。然而，后期随访显示旁路手术患者更具优势；血管成形术组在随访期间重复血运重建手术和晚期心肌梗死的发生率更高。在5年的随访中，与血管成形术组相比，旁路手术组在缓解致残性心绞痛方面更具优势（99%对89%；p=0.01），且生存率有改善趋势（76%对67%；p=0.09）。晚期死亡率的多变量相关因素包括年龄和血运重建不完全，但不包括血运重建方式。因此，对于患有多支冠状动脉疾病和左心室功能障碍的患者，早期结果显示血管成形术更具优势，而后期随访则显示旁路手术更具优势。然而，两组完全血运重建的患者后期生存率相似。
