Faxon D P
University of Southern California School of Medicine, Los Angeles, USA.
Am Fam Physician. 1997 Oct 1;56(5):1409-18.
In patients with coronary artery disease and severe ischemia, angioplasty and coronary artery bypass surgery have been shown to reduce symptoms, improve functional capacity and, in some patients, prolong life. Six major randomized trials have recently been reported comparing bypass surgery with angioplasty in patients with multivessel coronary disease. Uniformly, these studies demonstrate an equal mortality and reinfarction rate over five years of follow-up. Patients with angioplasties needed a repeat procedure during follow-up far more frequently than patients with bypass needed an additional bypass procedure (30 to 40 percent versus 5 to 10 percent). Although angioplasty was initially less costly, over five years the costs for the two procedures were similar. Mortality rates decreased by twofold when patients with diabetes mellitus were treated with bypass surgery rather than angioplasty. These studies confirm that in nondiabetic patients, bypass surgery and angioplasty are equally effective in the treatment of severe coronary disease. In diabetic patients with severe disease, however, bypass surgery is favored.
在患有冠状动脉疾病和严重缺血的患者中，血管成形术和冠状动脉搭桥手术已被证明可以减轻症状、改善功能能力，并且在某些患者中可以延长生命。最近有六项主要的随机试验报告，比较了多支冠状动脉疾病患者的搭桥手术和血管成形术。这些研究一致表明，在五年的随访中，两者的死亡率和再梗死率相同。接受血管成形术的患者在随访期间需要重复手术的频率远高于接受搭桥手术的患者需要额外进行搭桥手术的频率（30%至40%对5%至10%）。虽然血管成形术最初成本较低，但在五年内，这两种手术的成本相似。糖尿病患者接受搭桥手术而非血管成形术时，死亡率降低了两倍。这些研究证实，在非糖尿病患者中，搭桥手术和血管成形术在治疗严重冠状动脉疾病方面同样有效。然而，在患有严重疾病的糖尿病患者中，搭桥手术更受青睐。
