Rupprecht H J, Hamm C, Ischinger T, Dietz U, Reimers J, Meyer J
Medical Clinic II, University of Mainz, Germany.
Eur Heart J. 1996 Aug;17(8):1192-8. doi: 10.1093/oxfordjournals.eurheartj.a015036.
Although several randomized trials have been performed to compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) in patients with multivessel disease, there is little data available on angiographic follow-up results. The present substudy of the German angioplasty versus bypass surgery investigation (GABI Trial) compares the angiographic revascularization status in these two cases 6 months after treatment. Follow-up angiograms were available in 102 CABG patients and 117 PTCA patients. Although the protocol excluded patients with total occlusion, on follow-up 6 months after treatment we found total occlusion of 94 native arteries (36.9%) in the CABG group and of six arteries (2.5%) in the PTCA group (P < 0.001). The rate of occluded native vessels did not correlate significantly with the severity of the lesion before bypass surgery. In the CABG group 31 bypass grafts (12.2%) were found to be occluded at the 6 month follow-up examination (29/225 vein grafts [12.9%]; 2/30 mammary artery grafts [6.7%]). The main pathway, defined as the nutrient vessel (native vessel or bypass graft) providing the least resistance to blood flow, was narrowed by a lesion with a diameter stenosis of 70-100% for 36 target lesions (14.1%) in the CABG group and 39 target lesions (16.2%) in the PTCA group (P, ns). However, the prevalence of moderately severe lesions with a 50-69% diameter reduction of the main pathway was significantly greater in the PTCA group (44 lesions, 18.3%) than in the CABG group (19 lesions, 7.5%, P < 0.01). Thus, 6 months after randomized allocation to PTCA or CABG, we found comparable rates of high-grade lesions in the main pathways of both treatment groups. Whereas moderately severe lesions of the main pathway were predominantly seen in the PTCA group, there was marked disease progression to total occlusion in the native circulation after bypass grafting.
尽管已经进行了多项随机试验来比较经皮腔内冠状动脉成形术（PTCA）和冠状动脉旁路移植术（CABG）在多支血管病变患者中的治疗结果，但关于血管造影随访结果的数据却很少。德国血管成形术与旁路手术研究（GABI试验）的本项亚研究比较了这两种情况下治疗6个月后的血管造影血运重建状态。102例接受CABG的患者和117例接受PTCA的患者有随访血管造影照片。尽管方案排除了完全闭塞的患者，但在治疗后6个月的随访中，我们发现CABG组有94条自身动脉（36.9%）完全闭塞，PTCA组有6条动脉（2.5%）完全闭塞（P<0.001）。自身血管闭塞率与旁路手术前病变严重程度无显著相关性。在CABG组，31条旁路移植物（12.2%）在6个月随访检查时被发现闭塞（29/225条静脉移植物[12.9%]；2/30条乳内动脉移植物[6.7%]）。主要通路定义为对血流阻力最小的滋养血管（自身血管或旁路移植物），CABG组36个靶病变（14.1%）和PTCA组39个靶病变（16.2%）的主要通路因直径狭窄70%-100%的病变而变窄（P，无显著性差异）。然而，主要通路直径减少50%-69%的中度严重病变的发生率在PTCA组（44个病变，18.3%）显著高于CABG组（19个病变，7.5%，P<0.01）。因此，在随机分配接受PTCA或CABG治疗6个月后，我们发现两个治疗组主要通路中高级别病变的发生率相当。虽然主要通路的中度严重病变主要见于PTCA组，但旁路移植术后自身循环中病变进展至完全闭塞的情况较为明显。
