老年多支血管病变患者置入药物洗脱支架与冠状动脉旁路移植术后近远期临床结果

目的:本研究旨在比较老年(年龄≥75岁)稳定性冠心病合并多支血管病变患者行经皮冠状动脉介入治疗(PCI)置入药物洗脱支架(DES)与冠状动脉旁路移植术(CABG)的近远期临床结果。方法:本研究于2003年7月至2006年12月,连续入选年龄≥75岁稳定性冠心病合并多支血管病变患者363例,在我院行PCI置入DES(n=269)或CABG(n=94)治疗。主要终点为24个月时主要不良心脑血管事件(MACCE),次要终点为24个月时全因死亡及非致死性心肌梗死(MI)、脑血管事件和再次血运重建以及全因死亡、非致死性MI和脑血管事件复合终点事件。结果:住院期间,CABG组的病死率(7.4%vs.1.9%,P=0.023)和非致死性MI的发生率(3.2%vs.0,P=0.023),明显高于DES组,CABG组的MACCE的发生率也明显高于DES组(10.6%vs.1.9%,P=0.001)。多因素回归分析结果显示:24个月时,CABG组和DES组的主要终点事件的风险未见明显差异22.3%vs.15.2%,风险比(HR)=1.62,95%CI 0.63～3.31,P=0.379],两组的全因死亡、心源性死亡、非致死性MI、脑血管事件和再次血运重建的风险也没有明显差异;CABG组全因死亡、非致死性MI和脑血管事件复合终点事件的风险明显高于DES组(19.1%vs.8.2%,HR 3.87,95%CI:1.24～12.37,P=0.009)。结论:本研究提示,与DES相比,CABG可能会增加75岁以上多支血管病变患者的远期全因死亡、非致死性MI和脑血管事件复合终点事件的风险,而未降低再次血运重建和MACCE。

Comparison of short-term and long-term clinical outcomes following drug eluting stenting vs.coronary artery bypass grafting in the elderly patients with multivessel disease

Objective:This observational study compared percutaneous coronary intervention(PCI) with drug eluting stents(DES) vs.coronary artery bypass grafting(CABG) among the elderly patients(≥75 years) suffering stable coronary heart disease with multivessel disease for short-term and long-term clinical outcomes.Methods: We consecutively included 363 the elderly patients(≥75 years) suffering stable coronary heart disease with multivessel disease who underwent either PCI with DES(n=269) or CABG(n=94) in our institution from July 2003 to December 2005.The primary endpoints was major adverse cardiac and cerebrovascular event(MACCE) at 24 months,the secondary endpoints were all cause death,nonfatal myocardial infarction(MI),cerebrovascular events,repeat revascularization and the composite of all cause death,nonfatal MI or cerebrovascular events at 24 months.Results: Patients undergoing CABG had significantly lower in-hospital adverse outcome rates for mortality(7.4% vs.1.9%,P=0.023),nonfatal MI(3.2% vs.0%,P=0.023),and MACCE(10.6% vs.1.9%,P=0.001).After adjusted with Cox regression,the risk of primary end points at 24-month was not significantly different 22.3% vs.15.2%,Hazard ratio(HR): 1.62,95% confidence interval(CI): 0.63 to 3.31,P=0.379] between CABG and DES;moreover,all cause death,cardiac death,nonfatal MI,cerebrovascular events and subsequent repeat revascularization at 24 months were also similar.However,CABG significantly increased the risk of the composite of all cause death,nonfatal MI or cerebrovascular events at 24 months(19.1% vs.8.2%,HR: 3.87,95% CI: 1.14 to 12.37,P=0.009).Conclusion: In a real-world elderly patients(≥75 years) population,CABG may increase the risk of the composite endpoints of all cause death,nonfatal MI or cerebrovascular events at long terms compared with DES without decreasing the risk of repeat revascularization,or MACCE.