老年无保护左主干病变置人药物洗脱支架与行冠状动脉旁路移植术的预后比较

目的 对比老年无保护左主干病变患者置入药物洗脱支架(DES)和行冠状动脉旁路移植术(CABG)后2年的临床预后.方法 入选2004年1月至2006年6月因无保护左主干病变置入DES或行CABG的老年患者(≥70岁)共295例.随访2年,记录患者发生全因死亡、非致死性心肌梗死及靶病变血管重建的情况.结果 共206例患者行CABG,89例患者置入DES.随访2年的累积死亡率CABG组为10.2%,DES组为13.3%,两组之间差异无统计学意义(P=0.428).生存分析表明2年生存率CABG组为89.2%,DES组为86.4%,两组之间差异无统计学意义(P=0.668).2年心肌梗死发生率CABG组为10.1%,DES组为7.8%,两组之间差异无统计学意义(P=0.501).DES组2年内靶病变血管重建的发生率明显高于CABG组(13.5%比4.9%,P=0.015).多因素分析表明,年龄(HR:1.04,95% CI:1.01～1.09,P=0.024)、左心室功能不全(LVEF<30%)(HR:4.97,95%CI:1.22～24.85,P=0.018)以及2型糖尿病(HR:2.22,95%CI:1.31～4.86,P=0.001)均是死亡的独立危险因素.结论 对于≥170岁的老无保护左主干病变患者,行CABG和置入DES后2年的生存率相当,但置入DES的患者靶病变血管重建发生率明显高于行CABG的患者.

Comparison between drug eluting stent and coronary artery bypass grafting surgery for the treatment of unprotected left main coronary artery disease in elderly patients

Objective To compare the 2 years outcome of elderly patients with ULMCA stenesis undergoing coronary artery bypass grafting (CABG) or drug eluting stent(DES). Methods From January 2004 to June 2006, 295 patients with ULMCA stenosis and age ≥ 70 years undergoing coronary revascularization with either CABG (n = 206) or DES (n = 89) were enrolled in this analysis. All-cause death, non-fatal myocardial infarction and target lesion revascularization (TLR) were recorded during 2 years follow-up. Results The cumulative rate of 2-year mortality were 10.2% (n = 21) in CABG-treated patients and 13.3% (n = 12) in DES-treated patients (P = 0.428). The survival rate during 2-year follow-up was 89.2% for CABG-treated patients and 86. 4% for DES-treated patients (P = 0.668). The incidence of 2-year myocardial infarction was 7. 8% (n = 16) in CABG-treated patients and 10.1% (n =9) in DES-treated patients (P = 0.501). The incidence of target lesion revascularization (TLR) was 4.9% (n=10) in CABG-treated patients and 13.5% (n = 12) in DES-treated patients (P=0.015). In the multivariable analysis, age (HR: 1.04,95% CI: 1.01-1.09, P=0.024), left ventricular dysfunction (ejection fraction < 30%, HR: 4. 97,95 % CI: 1.22-24. 85, P=0.018) and type 2 diabetes (HR: 2.22, 95% CI:1.31-4.86,P=0.001) were independent predictors of 2-year mortality. Conclusion In this study, 2-yaer mortality was comparable in elderly patients with ULMCA stenesis underwent CABG or DES. However, the rate of TLR was significantly higher in patients treated with DES than that receiving CABG operation.