经皮冠状动脉介入术和冠状动脉旁路移植术对80岁以上左前支慢性闭塞患者的疗效比较

Comparison of the efficacy of percutaneous coronary intervention and coronary artery bypass grafting in octogenarian with chronic total occlusion of left anterior descending artery

目的:比较经皮冠状动脉(冠脉)介入术(percutaneous coronary intervention,PCI)和冠脉旁路移植术(coronary artery bypass grafting,CABG)对80岁以上老年单纯左前降支慢性闭塞患者的临床疗效。方法:自2016年1月至2020年7月,73例在我院接受PCI和CABG的80岁以上单纯左前降支慢性闭塞病变的患者为研究对象,42例患者接受PCI(PCI组),31例患者接受CABG(CABG组)。详细记录2组患者的临床特征、生化指标、住院期间和1年随访期间的主要心脏不良事件(包括死亡、心绞痛复发及因心肌缺血所致的再次血运重建等)。结果:2组患者年龄、性别构成、吸烟、高血压、糖尿病、高血脂、脑卒中、陈旧性心肌梗死、既往PCI史、外周血管疾病史及SYNTAX评分差异无统计学意义(均P>0.05),PCI组和CABG组的手术成功率(90.5%比97.1%,P=0.473)和再次血运重建率(7.89%比2.86%,P=0.667)差异无统计学意义。与CABG组相比,PCI组的费用[(7.34±1.54)万元比(11.77±1.34)万元,P=0.000]和住院天数[(4.62±0.67)d比(10.00±1.90)d,(P=0.000)]明显较少。结论:PCI治疗和CABG是2种对80岁以上老年单纯左前降支慢性闭塞患者的有效血运重建方法,相对而言,PCI治疗费用较少,患者恢复较快。

Objective To compare the clinical efficacy of percutaneous coronary intervention(PCI)and coronary artery bypass grafting(CABG)for octogenarians with chronic total occlusion of the left anterior descending artery.Methods From January 2016 to July 2020,a total of 73 octogenarians with chronic total occlusive disease of the left anterior descending artery who received interventional therapy and CABG in our hospital were enrolled in the study,in which 42 patients re-ceived interventional therapy and 31 patients underwent CABG.The clinical characteristics and incidence of major ad-verse cardiac events(including death,recurrence of angina pectoris and revascularization due to ischemia)during the hos-pitalization and one-year follow-up period were recorded in detail.Results There was no significant difference between two groups in age,gender composition,smoking,hypertension,diabetes,hyperlipidemia,stroke,history of myocardial infarc-tion,history of previous PCI,history of peripheral vascular disease and SYNTAX score(all P>0.05).There was no significant difference between two groups in the rate of successful revascularization(90.5%vs 97.1%,P=0.473),and the rate of target vessel revascularization during one-year follow up period(7.89%vs 2.86%,P=0.667).Compared with the CABG group,the cost of the PCI group[(73400±15400)CNY vs(117700±13400)CNY,P=0.000]and length of hospital stay in[(4.62±0.67)d vs(10.00±1.90)d,P=0.000]were significantly lower.Conclusions The PCI and CABG are two effective revascularization methods for octogenarians with chronic total occlusion of the left anterior descending artery.Compared with CABG,PCI is less expensive and the length of hospital stay is shorter.