雷帕霉素洗脱支架与冠状动脉旁路移植术治疗多支病变冠心病疗效的比较

Comparison of the effects of rapamycin-eluting stent implantation and coronary artery bypass grafting in treatment of patients with multi-vessel coronary disease

目的比较雷帕霉素洗脱支架术与冠状动脉旁路移植术(CABG)治疗多支冠状动脉病变的临床疗效。方法分析2002年1月至2004年12月行完全血运重建的512例多支冠状动脉病变患者的临床资料,其中接受CABG262例,接受雷帕霉素洗脱支架术250例,比较其围术期及随访期间临床疗效。结果雷帕霉素洗脱支架组比CABG组手术成功率高(100%比96·6%,P<0·01),住院期间总病死率和主要不良心脏事件(MACE)发生率均明显低于CABG组(1·2%比5·3%和1·6%比5·3%,均P<0·05),但2组住院期间无事件存活率比较差异无统计学意义。出院后2组患者平均随访时间19个月±14个月,随访率、MACE发生率、心绞痛复发率及无事件存活率差异均无统计学意义,但CABG组心力衰竭死亡率显著高于雷帕霉素洗脱支架组(10·9%比4·8%,P<0·05)。结论雷帕霉素洗脱支架术治疗多支冠状动脉病变患者长期疗效与CABG相当,是治疗多支病变冠心病患者一种较好的方法。

Objective To compare the clinical effects of rapamycin-eluting steat implantation and coronary artery bypass grafting （CABG） in treatment of the patients with multi-vessel coronary disease. Methods From January 2002 to December 2004, 262 patients with multi-vessel coronary disease underwent CABG, and 250 age, clinical characteristics, and characteristics of coronary disease-matched patients chose to receive rapamycin-eluting stent implantation. 6 - 9 months after the treatment angiography of the coronary artery was conducted. All the patients were followed up for 19 ~ 14 months. The clinical outcomes were compared. Results No intra-operative death occurred in the rapamycin-eluting stent implantation group with an operation success rate of 100%, significantly higher than that of the CABG group with. 9 intra- operative deaths and an operation success rate of 96.6% （ P 〈 0.01 ）. Three perioperative deaths occurred in the rapamycin-eluting steat implantation with a perioperative death rate of 1. 2%, not significantly different from that of the CABG group （ 1.9% with 5 perioperative deaths）. The total death rate during hospitalization of the rapamycin-eluting stent implantation group was 1.2%, significantly lower than that of the CABG group （5.3%, P 〈0.05）. The rate of in-hospital major adverse cardiac event （MACE） of the rapamycin-eluting stent implantation group was 1.6%, significantly lower than that- of the CABG group （5. 3% , P 〈 0.05 ）. There was no significant difference in MACE rate and angina pectoris recurrence during follow-up and event-free survival rate between these 2 groups. Conclusion A better treatment for the patients with multi-vessel coronary disease, rapamycin-eluting stent implantation has the clinical effects comparable to those of the CABG.