冠心病多支病变雷帕霉素洗脱支架置入与冠状动脉旁路移植术的疗效对比

目的:对比雷帕霉素洗脱支架(SES)置入与冠状动脉旁路移植术(CABO)的近期与中期临床疗效.方法:单中心回顾性连续入选2003年7月～2004年6月期间行择期血运重建的多支冠状动脉病变患者,分为CAB(;组(811例),SES组(251例).随访终点事件包括死亡、心肌梗死、脑卒中和再次血运重建等主要不良心脑血管事件(MACCE).采用Kaplan-Meier方法估计无事件生存率.采用Logistic多元回归方法调整分析治疗对终点事件的相对影响.结果:随访率90.3%.中位随访时间19个月.随访30 d,CABG组MACCE的发生率高于SES组(5.4%: 1.6%,OR 3.66,95%CI 1.26～10.61),CABG组的病死率高于SES组(4.6%:1.2%,OR4.02,95%CI 1.18～13.74).至随访结束,SES组累积病死率低于CAB(;组(3.1%:7.6%,OR 0.44,95%CI0.19～0.99),但再次血运重建率高于CABG组(8.4%:1.5%,OR 6.83,95%CI 3.07～15.19),MACCE 2组间差异无统计学意义.以30 d为分期分析,CABG组30d生存率低于SES组(95.4%;98.8%,P＜0.05),2组30d后生存率差异无统计学意义(97.2%:98.3%,P＞0.05).结论:多支冠状动脉病变CABG与SES置入比较,CABG的30 d病死率高于SES置入,30 d后病死率差异无统计学意义;多支冠状动脉SES置入的中期血运重建率高于CABG.

Effectiveness comparison of coronary artery bypass grafting and sirolimus eluting stent implantation in patients with multivessel disease

Objective:To provide a comparison of short-and mid-term clinical adverse events after coronary artery bypass surgery versus sirolimus-eluting stents for percutaneous coronary intervention in patients with multivessel disease.Method:The patients with multivessel coronary artery disease who underwent elective revascularization in a single center between July 2003 and June 2004 were included and divided into two groups:CABG group(n=811),SES group(n=251).The follow-up for clinical end points of death,myocardial infarction,stroke and any repeat revascularization were made through case record review and mainly by telephone interview after discharge retrospectively.Event free survival was estimated by Kaplan-Meier method.The adjusted treatment effect on the end points was analyzed by stepwise Logistic regression.Result:At 30-day follow-up,the incidence of MACCE was higher in CABG group than in SES group(5.4% versus 1.6%,OR 3.66,95% CI 1.26-10.61),more deaths were found in CABG group than in SES group(4.6% versus 1.2%,OR 4.02,95% CI 1.18-13.74).At the end of follow-up,death rate was lower(3.1% versus 7.6%,OR 0.44,95% CI 0.19-0.99),and repeat revascularization rate higher in SES group than in CABG group(8.4% versus 1.5%,OR 6.83,95% CI 3.07-15.19),no differences were found in the incidences of MACCE betweeo the two groups.At 30 days,the survival rate of CABG group was lower than that of SES group(95.4% versus 98.8%,P<0.05).From 30 days after revascularization to the end of follow-up no difference in survival rate was found between the two groups(97.2% versus 98.3%,P>0.05).Conclusion:Our study suggested that in the treatment of multivessel coronary artery disease the death rate of CABG was higher than that of SES implantation at 30 days,but the difference disappeared later on,and that mid-term repeat revascularization rate is higher in SES than in CABG.