药物洗脱支架与冠脉搭桥术对老年三支冠脉病变的疗效及费用分析

Analysis of effectiveness and cost of drug-eluting stents and Coronary-Artery Bypass Graft for elderly with three-vessel coronary disease

目的比较药物洗脱支架(PCI)与冠状动脉搭桥术(CABG)对老年三支冠脉病变的治疗效果及费用。方法选取2007年4月—2008年11月进行冠脉血运重建的176例三支病变的老年患者(年龄60～79岁),其中PCI组106例,CABG组70例。通过术后6个月和12个月随访比较两组终点事件和治疗费用。结果 PCI组平均住院及术后住院日较CABG组明显缩短(10.77±4.92)d比(46.20±16.19)d,(7.68±4.11)d比(19.51±10.04)d;PCI组完全血运重建率与CABG组相比差异有统计学意义(26.4%比100%,P<0.001)。两次随访两组死亡、心梗及脑卒中发生率无明显差异;PCI组的再血管化治疗高于CABG组(P<0.05);心绞痛及胸闷气短差异无统计学意义(P<0.05);CABG组伤口疼痛发生率显著高于PCI组(P<0.05)。总MACCE事件CABG组虽显著低于PCI组(10.0%比21.7%,P=0.04),但将PCI组中计划内分次进行的血运重建从总MACCE中除去后,两组间差异无统计学意义(P=0.09)。联合终点事件两组间亦差异无统计学意义(P=0.08)。总住院费用及药物费用CABG组显著高于PCI组(P<0.001)。手术费用两者相似(P=0.83)。术后治疗费用PCI组显著高于CABG组(P<0.001)。1年总费用CABG组显著高于PCI组(P<0.001)。两组中完全血运重建者1年费用总和CABG组仍显著高于PCI组(P<0.001)。术后PCI组抗血小板及他汀用药显著优于CABG组。结论对老年三支冠脉病变患者进行药物洗脱支架与冠脉搭桥术的疗效和费用进行综合分析后,提示药物洗脱支架治疗优于冠脉搭桥。

Objective To compare the treatment effect and cost of drug-eluting stents versus coronary-artery bypass graft for elderly with three-vessel coronary disease. Methods A total of 176 elderly patients （60y≤age≤79y） with three-vessel coronary disease underwent coronary revascularization,among them 106 cases with PCI and 70 cases with CABG. The comparisons were made in terms of the clinical outcomes and the treatment cost during follow-up. Results The mean time of hospital stay and postprocedural hospital stay was shorter in the PCI group than in the CABG group（10.77±4.92 d vs 46.20±16.19 d,7.68±4.11 d vs 19.51±10.04 d;both P0.001）. The rates of complete revascularization between the two groups were different （26.4% vs 100% P0.001）. The mortality rates and incidence of myocardial infarction and stroke were similar between the two groups. The rate of repeat revascularization was higher in the PCI group than in the CABG group （P0.05）. The incidence of angina,chest tightness and shortness of breath were of no significantly difference （P0.05）. The incidence of wound pain was greater in the CABG group （P0.05）. The incidence of the total MACCE in the CABG group was lower than in the PCI group （10.0% vs 21.7% P= 0.04）,but no difference was found after excluding the factor of repeat revascularization （P=0.09）. The combined end point was of no significant difference between the two groups （P=0.08）. The total charges and expenses during hospitalization were higher in the CABG group than in the PCI group （P0.001）. The surgery cost was similar between the two groups （P=0.83）. The treatment cost after the operation was significantly higher in the PCI group （P0.001）. The total cost of one year after operation was higher in the CABG group （P0.001）. The total cost of complete revascularization for the first year was higher in the CABG group （P0.001）. Conclusions Through a comprehensive analysis the effectiveness and cost of drug-eluting stents and coronary-artery bypass graft for elderly with three-vessel coronary disease it shows that the drug-eluting stents treatment is more preferable to the coronary-artery bypass graft in elderly with three-vessel coronary disease.