老年无保护左主干病变置人药物洗脱支架与行冠状动脉旁路移植术的预后比较

Objective To compare the 2 years outcome of elderly patients with ULMCA stenesis undergoing coronary artery bypass grafting (CABG) or drug eluting stent(DES). Methods From January 2004 to June 2006, 295 patients with ULMCA stenosis and age ≥ 70 years undergoing coronary revascularization with either CABG (n = 206) or DES (n = 89) were enrolled in this analysis. All-cause death, non-fatal myocardial infarction and target lesion revascularization (TLR) were recorded during 2 years follow-up. Results The cumulative rate of 2-year mortality were 10.2% (n = 21) in CABG-treated patients and 13.3% (n = 12) in DES-treated patients (P = 0.428). The survival rate during 2-year follow-up was 89.2% for CABG-treated patients and 86. 4% for DES-treated patients (P = 0.668). The incidence of 2-year myocardial infarction was 7. 8% (n = 16) in CABG-treated patients and 10.1% (n =9) in DES-treated patients (P = 0.501). The incidence of target lesion revascularization (TLR) was 4.9% (n=10) in CABG-treated patients and 13.5% (n = 12) in DES-treated patients (P=0.015). In the multivariable analysis, age (HR: 1.04,95% CI: 1.01-1.09, P=0.024), left ventricular dysfunction (ejection fraction < 30%, HR: 4. 97,95 % CI: 1.22-24. 85, P=0.018) and type 2 diabetes (HR: 2.22, 95% CI:1.31-4.86,P=0.001) were independent predictors of 2-year mortality. Conclusion In this study, 2-yaer mortality was comparable in elderly patients with ULMCA stenesis underwent CABG or DES. However, the rate of TLR was significantly higher in patients treated with DES than that receiving CABG operation.

Comparison between drug eluting stent and coronary artery bypass grafting surgery for the treatment of unprotected left main coronary artery disease in elderly patients