药物洗脱支架置入术与冠状动脉旁路移植术治疗冠心病多支病变的临床对比研究

目的:探讨药物洗脱支架(DES)治疗冠心病多支冠状动脉(冠脉)病变患者的临床疗效,并与冠脉旁路移植术进行比较.方法:入选2005-01-2008-01在我院行血管重建术的215例冠心病多支冠脉病变患者,其中114例行DES置入术(DES组),101例行冠脉旁路移植术 (CABG组).比较2组住院期和随访期不良心血管事件(死亡、非致死性心肌梗死、再次血管重建术和脑血管意外)的发生情况.结果:2组的临床和冠脉病变特征相似, 与DES组比较,CABG组左主干病变(29.2%∶5.0%,P<0.01)、LVEF<50%发生率(39.7%∶19.2%,P<0.01) 和完全血管重建率(81.2%∶58.8%, P<0.01)较高.住院期2组总体不良心血管事件发生率无明显差异,但CABG组住院期病死率有增高趋势(6.9%∶1.8%,P＞0.05).平均临床随访12～36(17±9)个月,2组总体不良心血管事件发生率仍无明显差异(9.6% ∶13.4%,P＞0.05) ,但DES组再次血管重建的发生率较CABG组有增高趋势(9.8%∶2.1%,P＞0.05).结论:DES置入术应用在冠心病多支冠脉病变患者中安全可行,总体不良心血管事件发生率与CABG无明显差异.

Clinical efficacy of drug-eluting stent implantation in patients with multi vessel coronary artery disease as compared with coronary artery bypass graft

Objective:To evaluate the clinical efficacy of drug-eluting stent (DES) implantation in patients with multi vessel coronary artery disease (MVD ) as compared with coronary artery bypass graft (CABG) on the clinical outcomes. Method:From Jan 2005 to Jan 2008, 215 patients with MVD were underwent revascularization, 114 by percutaneous coronary intervention with DES (DES group) and 101 by CABG(CABG groups). The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) during hospital stay and follow-up were compared between two groups, included any death, non fatal myocardial infarction, target vessel revascularization and cerebro vascular event. Result:Most preoperative characteristics were similar in the two groups, but left-main disease (29.2%CABG vs 5.0%DES, P<0.01) and Left ventricular ejection fraction (LVEF)<50%(39.7% CABG vs 19.2%DES, P<0.01) were more prevalent in CABG group. Completed vascularization was achieved in more patients in CABG group than in PCI group (81.2% CABG vs 58.8%DES, P<0.01). Cumulative incidence of MACCE during hospitalization was no statistical differences between the two groups, despite a higher tendency of early morbidity associated with CABG(6.1% vs 1.8%, P＞0.05). Patients were followed up clinically for a mean of( 17±9 )months ( range 12-36 months). The incidence of MACCEs remained no statistical differences between the two group(9.6% CABG vs 13.4%DES, P＞0.05).But there was more requirement for repeat revascularization in PCI group compared with CABG group (9.8% DES vs 2.1% CABG, P＞0.05).Conclusion:drug-eluting stent (DES) implantation is safe and effective for patients with multi vessel coronary artery disease (MVD ),It might leading to a lower tendency of early morbidity associated with CABG.The incidence of MACCEs was no statistical differences between DES and CABG.