冠状动脉完全闭塞再血管化的远期预后评估

目的比较经皮冠状动脉介入治疗（PCI），冠状动脉旁路手术（CABG）和药物治疗慢性冠状动脉完全闭塞病变的长期预
后。方法本研究为回顾性队列研究，患者选自解放军总医院心内科导管室2008~2009年间首次行冠状动脉造影的住院病人，
将慢性闭塞患者分为PCI组、CABG组和药物治疗组，对患者进行为期5年的随访，以严重不良心血管事件（MACE）作为终点。
结果PCI组录入患者192例、CABG组48例、药物治疗组13例。基线资料在3组中基本相同。但药物治疗组LDL及总胆固醇
水平较高（P<0.05）。CABG组SYNTAX积分明显较高（P<0.05）。共发生MACE事件43例，CABG组MACE事件23%，药物治
疗和PCI 术后MACE分别为15%和16%，差异无统计学意义（P>0.05）。PCI 和CABG术后的全因死亡为10%，药物治疗组为
15%，差异无统计学意义（P=0.62）。CABG术后发生脑卒中的比例较高为8%，PCI术后为3%，差异无统计学意义（P>0.05）。3
种治疗方法的生存曲线基本重叠，没有统计学差异。结论尽管再血管化治疗的即刻效果明显，但本研究未能显示闭塞病变采
取CABG、单纯药物治疗和PCI术对远期预后有明显影响，但是CABG的中风发生率偏高。

Long-term outcome of patients undergoing recanalization procedures for chronic totalcoronary occlusion

Objective To compare the long-term outcomes of patients receiving percutaneous coronary intervention (PCI),
coronary artery bypass grafting (CABG), or medical therapy for treatment of chronic total coronary occlusion (CTO). Methods
The patients with CTO were selected from a consecutive cohort of patients who underwent coronary angiography (CAG)
between 2008 and 2009. The patients with multiple CAG were excluded. The patients received treatments with PCI, CABG, or
conservative medication therapy and were followed for major adverse cardiovascular events (MACE) within 5 years. Results A
total of 253 patients were enrolled in this study, including 192 receiving PCI, 48 receiving CABG, and 13 treated conservatively
with medications. The baseline clinical characteristics were similar among the 3 groups except for increased low-density
lipoprotein (LDL) and total cholesterol (TC) in the medication group, and increased Syndax score in CABG group. During the
follow-up, the incidences of MACE, AMI, death, stroke or heart failure did not differ significantly among the 3 groups (P>
0.05). However, CABG group showed a higher incidence of the stroke than the other two groups although this difference did
not reach a statistically significantly level (P=0.06). Conclusion Our study did not demonstrate that recanalization offers
greater long-term benefits than medications for treatment of CTO, and the patients receiving CABG appeared to have a higher
incidence of stroke.