老年冠心病患者多支病变PCI与CABG治疗的远期疗效比较

目的:比较老年多支冠状动脉病变患者雷帕霉素洗脱支架植入(DES)与冠状动脉搭桥术(CABG)的远期疗效。方法:随机入选我院年龄大于75岁,并成功行择期血运重建的,有多支冠状动脉病变的住院患者322例,分为CABG组(160例),DES组(162例)。随访5年的主要不良心脑血管事件(MACE)。采用Kaplan-Meier方法估计无事件生存率。采用Logistic多元回归方法分析治疗对终点事件的影响。结果:322例随访率100%,与DES组比较,CABG组5年MACE发生率明显减低(18.52%比3.75%,P<0.05),再次血运重建率明显减低(12.3%比0.63%,P<0.01);两组间5年生存率无明显差异(98.8%比98.1%,P>0.05)。结论:高龄老年多支冠脉病变患者CABG与雷帕霉素洗脱支架植入比较,二者生存率无显著差异;但CABG组的远期心脑血管事件发生率、血运重建率显著低于雷帕霉素洗脱支架植入组。

Comparison of long-term effect between PCI and CABG in aged CHD patients with multiple vessel coronary disease

Objective： To compare long-term effect between rapamycin-eluting stent （DES） implantation anal coronary artery bypass graft （CABG） in aged patients with multiple vessel coronary disease （MVD）. Methods： A total of 322 MVD inpatients with age〉75 years old undergoing successful selective revascularization were randomly enrolled, and they were divided into DES group （n = 162） and CABG group （n = 160）. All patients were followed up for five years for major adverse cardiac and cerebrovascular events （MACE）. Kaplan-Meier method was used to evaluate no- event survival rate. Logistic multiple regression method was used to analyze influence of therapy on endpoint events. Results： Follow-up rate of 322 cases was 100%. In five-year follow-up, compared with DES group, incidence rate of MACE （18.52% vs. 3.75%, P〈0.05） and revascularization rate （12.3% vs. 0.63%, P〈0.01） significantly decreased in CABG group. There was no significant difference in five-year survival rate between two groups （98. 8% vs, 98.1%, P〉0.05）. Conclusion： Compared with rapamycin-eluting stent implantation, there is no significant difference in long-term survival rate in CABG group, but MACE incidence rate and revascularization rate of CABG group, are significantly decreased in aged patients with multiple vessel coronary disease.