Dagres N, Erbel R
Abteilung für Kardiologie, Universitätklinik-GH-Essen.
Med Klin (Munich). 1998 Jan 15;93(1):22-6, 58. doi: 10.1007/BF03045036.
The percutaneous transluminal coronary angioplasty (PTCA) and the coronary artery bypass surgery (CABG) are established therapy modalities for the coronary artery disease. Meanwhile, first results of randomized trials comparing both therapy forms have been published.
The results of the 6 large randomized trials (GABI, RITA CABRI, BARI, EAST, and ERACI) were compared and summarized. Inclusion criterium was coronary multivessel disease (in RITA also one-vessel-disease). Patients with left main stem stenosis, previous PTCA or CABG, severely depressed ejection fraction and total coronary occlusions were excluded in most trials. Between 127 and 1829 patients were randomized. Follow-up was 1 to 5 years.
There was no significant difference in mortality between the PTCA and the CABG-group, except in the diabetic patients of the BARI trial, who showed a significantly better survival after CABG. Mortality was 3 to 7% in most trials. The rate of myocardial infarction in the follow-up did not differ significantly. The prevalence of angina was higher in the PTCA-group in the first months after the procedure, but the difference became less marked during the follow-up. One year after the procedure, approximately 75% of the patients in the CABG-group and 70% in the PTCA-group were free from angina. The rate of additional revascularization procedures was significantly higher in the PTCA-group (32 to 54%) than in the CABG-group (3.2 to 13%). Treatment costs were significantly higher in the CABG-group.
Both therapy forms were very effective concerning treatment of angina without a significant difference in mortality or frequency of myocardial infarction. The PTCA patients required more revascularization procedures, the costs for their treatment were lower than in the CABG-group. The question, whether coronary stent implantation will influence these conclusions significantly, remains open.
经皮腔内冠状动脉成形术（PTCA）和冠状动脉搭桥手术（CABG）是治疗冠状动脉疾病的既定治疗方式。同时，比较这两种治疗方式的随机试验的初步结果已经发表。
对6项大型随机试验（GABI、RITA、CABRI、BARI、EAST和ERACI）的结果进行了比较和总结。纳入标准为冠状动脉多支病变（在RITA试验中也包括单支病变）。大多数试验排除了左主干狭窄、既往有PTCA或CABG史、射血分数严重降低和冠状动脉完全闭塞的患者。127至1829例患者被随机分组。随访时间为1至5年。
PTCA组和CABG组之间的死亡率无显著差异，但BARI试验中的糖尿病患者除外，这些患者在CABG术后生存率显著更高。大多数试验中的死亡率为3%至7%。随访期间心肌梗死发生率无显著差异。术后最初几个月，PTCA组心绞痛患病率较高，但随访期间差异变得不那么明显。术后一年，CABG组约75%的患者和PTCA组约70%的患者无心绞痛。PTCA组再次血管重建手术的发生率（32%至54%）显著高于CABG组（3.2%至13%）。CABG组的治疗费用显著更高。
两种治疗方式在治疗心绞痛方面都非常有效，死亡率或心肌梗死发生率无显著差异。PTCA患者需要更多的血管重建手术，其治疗费用低于CABG组。冠状动脉支架植入术是否会显著影响这些结论，这个问题仍然悬而未决。
