药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉多支病变的比较

目的比较药物洗脱支架与冠状动脉旁路移植术治疗冠状动脉复杂多支病变的疗效。方法连续入选行血运重建治疗的冠心病多支病变患者200名,随机分为经皮冠状动脉介入(PCI)组和冠状动脉旁路移植术(CABG)组,每组100例。PCI组和CABG组中分别有合并糖尿病者(糖尿病亚组)27例和25例。观察术后1年内主要心脑血管不良事件(死亡、脑卒中、非致死性心肌梗死、靶血管再次血运重建)、再狭窄、心绞痛复发发生率,血浆肌酸激酶水平和PCI组支架内血栓形成发生率。结果两组患者的基线特征差异无统计学意义。PCI组与CABG组1个月、6个月和1年的主要心脑血管不良事件发生率分别为4.0%、7.0%、12.0%比6.0%、9.0%、15.2%(P>0.05);心绞痛复发率分别为2.0%、4.0%、6.0%比1.0%、3.0%、5.1%(P>0.05)。术后1年再狭窄率分别为11.3%比13.2%(P>0.05)。PCI组术后亚急性血栓形成率1.0%。PCI组和CABG组术后肌酸激酶MB型同工酶升高的患者比例分别为26%比82%(P<0.05)。PCI组糖尿病亚组与CABG组糖尿病亚组1个月、6个月和1年的严重心脑血管不良事件发生率分别为7.4%、11.1%、18.5%比8.0%、16.0%、24.0%(P>0.05)。结论药物洗脱支架时代PCI与CABG治疗冠状动脉多支病变的近、远期疗效相近,对于合并糖尿病的患者同样有效。

Drug-eluting stent versus coronary artery bypass surgery in the treatment of patients with multivessel de novo coronary artery lesions

Objective To compare the efficacy and safety of drug-eluting stent and coronary artery bypass surgery for patients with multivessel de novo coronary artery lesions.Methods This study assigned 200 participants with multivessel de novo coronary artery lesions to either coronary artery bypass surgery or drug-eluting stenting.The primary clinical end points were the combined incidence of death,myocardial infarction,repeat revascularization and stroke at 1 year after the operation.Other end points included creatine kinase MB at 18 hours and restenosis at 1 year after the procedure.Results Both groups had similar baseline characteristics.The 1 month,6 month and 1 year composite end points of death,myocardial infarction,repeat revascularization and stroke were 4.0%,7.0%,12.0% vs.6.0%,9.0%,15.2% for the drug-eluting stent and coronary artery bypass surgery groups,respectively(P>0.05).The restenosis rates at 1 year were 11.3% for the drug-eluting stent group and 13.2% for the coronary artery bypass surgery group(P>0.05).Abnormal CK-MB elevation occurred in 26% of the patients with drug-eluting stent and in 82% of the patients receiving coronary artery bypass surgery(P<0.05).The 1 month,6 month and 1 year composite end point of death,myocardial infarction,repeat revascularization and stroke in diabetic patients were 7.4%,11.1%,18.5% vs.8.0%,16.0%,24.0% for the drug-eluting stent group and the coronary artery bypass surgery group,respectively(P>0.05).Conclusion One year after the initial procedure,percutaneous coronary intervention with multiple drug-eluting stents inplantation and coronary artery bypass graft surgery showed similar short and long term outcomes.Comparable result was observed in diabetic patients.