冠状动脉旁路移植术治疗高龄无保护左主干病变患者的长期预后分析

Long-term prognosis of coronary artery bypass grafting in elderly patients with unprotected left main artery disease

目的分析冠状动脉旁路移植术治疗高龄无保护左主干病变患者的长期预后。方法回顾性分析该院2010年1月至2014年6月收治的300例高龄无保护左主干病变患者临床资料,依据治疗方式不同分为采取冠状动脉旁路移植术治疗的冠状动脉旁路移植术组200例以及采取经皮冠状动脉介入术治疗的经皮冠状动脉介入术组100例,对术后5年随访结果进行对比。结果术后两组血管内超声结果、左心室射血分数均较术前明显提升(P<0.05),但组间差异无统计学意义(P>0.05);经皮冠状动脉介入术组再次血运重建率、全因死亡率、心源性死亡率、主要不良心脑血管事件发生率高于冠状动脉旁路移植术组,卒中发生率低于冠状动脉旁路移植术组,差异均有统计学意义(P<0.05),非致死性心肌梗死发生率、非致死性脑血管意外发生率与冠状动脉旁路移植术组数值相当,差异无统计学意义(P>0.05)。结论在高龄无保护左主干病变患者长期预后比较中冠状动脉旁路移植术取得的效果优于经皮冠状动脉介入术,但卒中风险更高。

【Objective】To analyze the long-term prognosis of elderly patients with unprotected left main artery disease treated by coronary artery bypass grafting.【Methods】The clinical data of 300 elderly patients with unprotected left main coronary artery disease admitted to our hospital from January 2010 to June 2014 were analyzed retrospectively.According to the treatment methods,they were divided into two groups:200 patients in coronary artery bypass grafting(CABG)group and 100 patients in percutaneous coronary intervention(PCI)group.Follow-up results at 5 years after surgery were compared.【Results】Intravascular ultrasound results and left ventricular ejection fraction of both two groups were significantly improved after treatment(P<0.05),but there was no significant difference between the two groups(P>0.05).The rate of revascularization,all-cause mortality,cardiogenic mortality,major adverse cardiovascular and cerebrovascular events in the PCI group were higher than those in the CABG group,the incidence of stroke in PCI group was lower than that in the CABG group,and the differences were statistically significant(P<0.05).There was no significant difference between the two groups in incidence of non-fatal myocardial infarction,incidence of non-fatal cerebrovascular accidents(P>0.05).【Conclusion】Compared with the long-term prognosis of the elderly patients with unprotected left main artery disease,the effect of coronary artery bypass grafting is better than that of percutaneous coronary intervention,but the risk of stroke is higher.