药物洗脱支架或冠状动脉搭桥术对冠状动脉多支病变的疗效观察

目的观察药物洗脱支架（DES）或冠状动脉旁路手术（CABG）对冠状动脉多支病变的疗效。方法回顾性分析350例冠心病患者的临床资料，其中冠脉多支病变220例，行DES置入术148例，行CABG术72例，观察其手术疗效、并发症，并临床随访再发心绞痛、再次血运重建、死亡无事件存活等。结果随访327例患者，随访率93．42％。随访结果：围手术期手术成功率均较高，CABG组70／72（97．22％），DES组143／148（96．62％），两组间差异无统计学意义（P〉0．05）。心力衰竭发生率，CABG组14／72（19．44％），高于DES组12／148（8．10％），差异有统计学意义（P〈0．05）。死亡率CABG组4／72（5．55％），略高于DES组6／148（4．05％），但差异无统计学意义。脑梗塞、心绞痛、多脏器功能衰竭发生率两组间差异均无统计学意义（P〉0．05）。术后（12．0±6．7）个月随访结果：再发心绞痛DES组9／148（6．48％），高于CABG组2／72（2．7％），差异有统计学意义（P〈0．05）。靶血管重建，DES组5／148（3．38％），高于CABG组0／72（0），两组间差异无统计学意义。结论对于多支冠状动脉病变，CABG组及DES组手术成功率均较高，两组间差异无统计学意义。DES组创伤小、恢复快，围手术期心力衰竭发生率CABG组高于DES组，差异有统计学意义。死亡率两组间差异无统计学意义。远期临床随访，两组均有较好的效果，再发心绞痛及需血运重建，DES组高于CABG组。

Effects of drug eluting stents or coronary artery bypass grafting on multi-branches lesions of coronary artery

Objective To observe the clinical effects of drug eluting stents on multi-branches lesions of coronary artery. Methods Clinical datas of 350 cases of coronary diseases were analyzed retrospectively. From them, 220 cases suffered multi-branches lesions of coronary artery including 148 cases with drug eluting stents （DES） implantation and 72 cases with coronary artery bypass grafting （CABG）. Effects, complications, recurrent angina pectoris, target vessel rebuilding, death and non-event existence were analyzed. Results 327 cases finished follow-up and the follow-up rate was 93.42%. Surrounding operation period, the successful rates were high in both CABG group （97.22% ,70/72） and DES group （96.62% ,143/148）,with no significant difference between two groups. Heart failure prevalence rate was significantly higher in CABG group （19.44%, 14/72） than DES group （8.10% ,12/148）（P〈0.05）. Mortality was also slightly higher in CABG group （5.55% ,4/72） than DES group （4.05%, 6/148）, but with no significant difference. There were no significant differences between two groups in the incidences of cerebral infarction, angina pectoris and multiple system organ failure. The follow-up period was 12±6.7 months. Recurrent angina pectoris rate was higher in DES group （6.48% ,9/148） than CABG group （2.7%,2/72）（P〈0.05）. Target vessel revaseularization rate was significantly higher in DES group （3.38%,5/148） than CABG group （0,0/72）（P〈0.05）. No differences were found between two groups in non-fatal myocardial infarction, new attack of heart failure, cerebral vessel diseases, eardiogenie death and non-event existence. Conclusion The successful rate is high in two groups with no significant difference. But in DES group, the trauma is smaller and the patients recover more quickly. Peri-operation period, the heart failure rate is significantly higher in CABG group than DES group. No significant difference is found in death rate between two groups. Recurrent angina pectoris and target vessel revascularazition were higher in DES group than CABG group during the follow-up period.