多支冠状动脉病变患者1911例PCI二年疗效

Two-year therapeutic effect of PCI in 1911 patients with multivessel coronary artery disease

目的 评价多支冠状动脉病变（MVD）通过经皮冠状动脉介入（PCI）进行血运重建的长期疗效。方法 1995年6月～2003年12月连续2028例在我院成功接受PCI的MVD患者，对其心绞痛复发率、造影复查再狭窄率和主要不良心脏事件（MACE）的发生率进行回顾分析。结果 2028例MVD患者，完全性血运重建率86．2％（1748／2028），住院期间共死亡26例（总病死率1．3％），对存活出院的2002例患者中的1911例随访24个月，随访率95．5％，其心绞痛复发率、造影复查再狭窄率和MACE发生率分别为10．7％、14．6％、25．4％，其中1754例植入普通金属支架（BMS），157例植入药物洗脱支架（DES）。尽管DES组患者冠心病危险因素多、病变程度复杂，不稳定心绞痛占61．8％、糖尿病占41．4％、慢性完全闭塞病变（CTO）占37．6％、3支病变占58．0％，但心绞痛复发率、造影复查再狭窄率和MACE发生率均显著低于BMS组（分别为4．5％vs11．2％，3．2％vs15．7％，8．9％vs26．9％，均P〈0．01）。结论 PCI进行血运重建是治疗MVD的有效方法，但仍存在BMS支架术后不良事件发生率高，DES用于治疗MVD具有更好的长期疗效。

AIM To retrospectively investigate the long-term therapeutic effect of percutaneous coronary intervention （PCI） on revascularization in patients with muhivessel coronary artery disease （MVD）. METHODS From June 1995 to December 2003, a total of 2028 patients with MVD were treated by PCI and the rates of angina recurrence, angiographic restenosis and major adverse cardiac events （MACE） were retrospectively analyzed. RESULTS Among the 2028 patients, complete revascularization rate was 86.2% （1748/2028）. The total in-hospital mortality rate was 1.3% （26/2028） and 2002 were discharged after treatment, of whom 1911 patients （95.5%） were followed up for 24 months. The rates of angina recurrence, angiographic restenosis and MACE were 10.7%, 14.6% and 25.4%, respectively. Of the 1911 cases, 1754 patients had been treated by bare metal stent（BMS） and 157 patients treated by drug-eluting stent （DES）. Although the patients treated by DES had more risk factors and more complex coronary lesions [61.8% with unstable angina, 41.4% with diabetes, 37.6% with chronic total occlusion （CTO） and 58.0% with triple-vessel disease ] , the post-PCI rates of angina recurrence, angiographic restenosis and MACE were significantly lower than those in patients treated by BMS （4.5% vs 11.2%, 3.2% vs 15.7% , 8.9% vs 26.9%, P〈0.01）. CONCLUSION The PCI revascularization is an effective treatment in patients with MVD, but the patients treated with BMS may have relatively higher MACE rate. DES has better long-term therapeutic effect in patients with MVD.