冠状动脉多支病变DES与CABG的疗效观察

Effects of Drug Eluting Stents and Coronary Artery Bypass Grafting on Multi-Branches Lesions of Coronary Arteries

目的:观察药物洗脱支架(DES)和冠状动脉旁路移植术(CABG)对冠状动脉多支病变的疗效。方法:220例多支病变冠心病(CHD)患者接受DES(148例)或CABG(72例),观察围术期疗效、并发症,进行临床随访了解远期疗效(再发心绞痛、再次血运重建、死亡、无事件存活等)。结果:围手术期DES和CABG的手术成功率均较高,两组间差异无统计学意义(P>0.05)。心力衰竭发生率CABG组高于DES组,差异有统计学意义(P<0.05);死亡、脑梗塞、心绞痛、多脏器功能衰竭发生率两组间无明显差异(P>0.05)。术后(12±6.7)个月随访结果示:DES组的再发心绞痛、靶血管重建高于CABG组,差异有统计学意义(P<0.05)。非致死性心肌梗死、新发心力衰竭、脑血管病、心脏性死亡、无事件存活率等两组间差异无统计学意义(P>0.05)。结论:CHD多支冠状动脉病变患者,CABG和DES的手术成功率均较高,近期疗效无明显区别。远期疗效观察,两组死亡率无明显区别,但CABG组的再发心绞痛及靶血管重建小于DES组。

Objective： To observe the clinical effects of drug eluting stents（DES） and coronary artery bypass grafting （CABG） on multi-branches lesions of coronary arteries. Methods：220 cases of multi-branches lesions of coronary arteries was treated with DES（148） or CABG（72）. The effects of DES and CABG were observed. The perioperative and long-term compliments were also observed, such as recurrent angina pectoris, target vessel rebuilding, death and non-event existence. Results：The similar higher success rates of DES and CABG were observed in these patients immeditately after operation（P〉0.05）, The incidence of heart failure in perioperative period was higher in CABG group than in DES group（P〈0.05）, but there were no significant differences between two groups in the incidences of cerebral infarction, angina peetoris and multiple system organ failure（P〉0.05）. Long-term follow-up（12a=6.7 months） results showed that the incidences of recurrent angina pectoris and target vessel rebuilding in DES group were higher than in CABG group（P〈0.05）, and there were no significant differences of non-fatal myocardial infarction, new attack of heart failure,cerebral vessel diseases, cardiogenic death and non-event existence between the two groups（P〉0.05）. Conclusions：The success rates of DES and CABG were similar in the patients of multi-branches lesions of coronary arteries, and there were no significant differences of two groups in perioperative period. The mortality rate of of the two groups in the long-term were also similar, but the incidence of recurrent angina pectoris and target vessel rebuilding were higher in DES group than in CABG group.