冠状动脉旁路手术、优化药物治疗和经皮冠状动脉介入治疗的全因死亡率的对比

目的比较评估冠状动脉旁路移植术(CABG)、优化药物治疗(OMT)和经皮冠状动脉支架植入术(PCI)的治疗效果。方法连续入选2008~2014年在解放军总医院第一医学中心心内科住院的冠状动脉造影(CAG)住院患者,按治疗方式的不同将入选患者分成CABG组,OTM组和PCI组,采用电话、门诊和查阅病历确定患者的存活状态,采用Kaplan-Meier方法进行生存分析,采用二元逻辑回归分析死亡的危险因素。结果共入选患者1 643例,其中CABG 283例,OTM 425例,PCI 935例。CABG组年龄最大,合并疾病脑卒中、高血压、既往心肌梗死最多,冠状动脉病变最严重,Syntax积分和血管狭窄积分最高,其次为PCI,再其次为OMT,差异有统计学意义(P <0.05)。OMT左室射血分数最低,其次为PCI,再其次为CABG,差异有统计学意义(P=0.004)。PCI组肌钙蛋白T最高,其次为CABG,再其次为OMT,差异有统计学意义(P=0.014)。OMT和PCI红细胞低于CABG,差异有统计学意义(P=0.026)。CABG组死亡27例(9.5%),OTM组死亡22例(5.2%),PCI为组死亡63例(6.7%),CABG的死亡率偏高(P=0.063)。CABG与OTM两两比较差异显著,差异有统计学意义(P=0.018)。男性、高龄、SYNTAX积分、红细胞降低,EF降低,右冠状动脉近端病变是老年患者死亡的危险因素(P <0.05)。结论远期随访显示CABG,OMT和PCI的死亡率大致相似,但CABG死亡率略高。男性、高龄、复杂病变、LAD近端病变、射血分数降低是老年患者死亡的危险因素。

Comparison of all cause mortality by CABG,optimal medical treatment and PCI

Objective To compare the mortality benefit of CABG,optimal medical treatment or PCI in the treatment of coronary artery disease.Methods P atients were consecutively recruited between January 2008 and January 2014 from the first medical center of PLA General Hospital.Coronary angiography was performed on all patients. Patients were divided into CABG,OMT and PCI, and they were followed by telephone,out-patient clinic and hospital medical records.Life table,Kaplan-meier,Student T test,Chi-squared test,analysis of variance,binary logistical regression analysis were used in the statistical analysis.Results A total of1643 patients were enrolled. Patients were divided into CABG(283),OMT(425)and PCI(935).The mortality rate of CABG was for9.54%,OMT 5.18%,PCI 6.74%,p =0.063.Paired comparisons:CABG vs OTM,p =0.018;CABG vs PCI,p =0.064;OMT vs PCI,p =0.412.The binary logistical regression analysis showed that gender,age,SYNTAX score,red blood cell account,proximal RCA lesion were related to death(P < 0.05).Proximal LAD lesion was also related to death but P=0.06.Conclusion CABG,OMT and PCI are equally effective treatment for CAD in term of mortality.Male,old age,complex CAD,proximal LAD lesion and poor EF will be better to treat with revascularization.