冠心病多支病变支架植入与冠脉旁路移植术疗效的比较

Comparison of effectiveness of coronary artery bypass grafting and sirolimus-eluting stent implantation in aged patients with multivessel disease

目的:比较老年冠心病多支冠状动脉病变患者的雷帕霉素洗脱支架植入与冠状动脉旁路移植术近期与中期的疗效。方法:回顾性入选2001年12月至2005年12月,行择期血运重建的多支冠状动脉病变患者,分为冠状动脉旁路移植术组(CABG组,n=310),雷帕霉素洗脱支架植入组(SES组,n=257)。随访包括死亡、心肌梗塞(MI)、卒中和再次血运重建的主要不良心脑血管事件(MACCE)。采用Kaplan-Meier方法估计无事件生存率。采用Logistic多元回归方法调整分析治疗对终点事件的相对影响。结果:随访率96.4%。中位随访时间24个月。随访30d,CABG组MACCE的发生率高于SES组(5.8%∶1.5%,P<0.05),CABG组的死亡率高于SES组(4.7%∶1.4%,P<0.05)。至随访结束,CABG组累积死亡率仍高于SES组(6.6%∶2.9%,P<0.05),但再次血运重建率低于SES组(1.6%∶8.6%,P<0.05),MACCE两组间无差异。结论:多支冠状动脉病变患者冠状动脉旁路移植术的死亡率高于雷帕霉素洗脱支架植入,中期血运重建率低于雷帕霉素洗脱支架植入。

Objective： To provide a comparison of short- android-term effectiveness between coronary artery bypass graft （CABG） and sirolimus-eluting stents （SES） implantation in aged patients with multivessel disease. Methods： The aged patients with muhivessel coronary artery disease who underwent elective revascularization in a single center between December 2001 and December 2005 were included in the study and divided into two groups： CABG group （n =310） and SES group （n=257）. The follow-up for major adverse cardiovascular and cerebral events （MACCE） of revascularization was made after discharge retrospectively. Event free survival was estimated by Kaplan-Meier method. The adjusted treatment effect on the end points was analyzed by stepwise Logistic regression. Results： The 96.4%0 Of all patients was followed successfully. The median time of follow-up was 24 months. At 30 day follow-up, the incidence of MACCE was higher in CABG group than that in SES group （5.8% ： 1.5%, P〈0. 05） more deaths werefound in CABG group than in SES group （4. 7% ： 1.4%, P〈0. 05）. At the end of follow-up, death rate was lower （2.9% ： 6.6%, P〈0.05）, and repeat revascularization rate higher in SES group than those in CABG group （8.6% ： 1.6%, P〈0.05）, no differences were found in the incidences of MACCE between two groups. Conclusion： The result suggests that in the treatment of multivessel coronary artery disease the death rate of CABG is higher than that of SES implantation, but the mid-term repeat revascularization rate is higher in SES use.