严重左心室扩张患者行经皮冠状动脉介入治疗和冠状动脉旁路移植术的对比研究

Comparison of percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe left ventricular dilatation

目的对比严重左心室扩张（LVD）患者行经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的近期和远期临床结果。方法选择2003年7月至2005年9月在我院接受PCI或CABG治疗的严重LVD患者251例，分析不同血运重建方式对住院和随访期间不良心脑血管事件（MACCE）的影响。结果严重LVD患者接受PCI治疗101例，CABG治疗150例，其中PCI组的住院MACCE发生率低于CABG组[3．O％（3／101）比10．7％（16／150），P=0．024]，住院病死率分别为2．0％、8．7％（P=0．028）。PCI组和CABG组分别随访（516±182）d和（515±231）d（P=0．967），分别有99例（98．0％）和136例（90．7％）完成随访。两组随访MACCE发生率PCI组、CABG组分别为18．2％（18／99）、9．6％（13／136）差异无统计学意义（P=0．054），PCI组再次血运重建率（14．1％、14／99）比CABG组高（0．7％、1／136，P〈0．01），两组随访死亡[4例（4．0％）比12例（8．8％），P=0．151]、心肌梗死[2例（2．0％）比1例（0．7％），P=0．781]和脑卒中[2例（2．0％）比0例（0．0％），P=0．176]的发生率相当。结论严重LVD患者接受PCI安全可行，其住院病死率较低，远期预后与CABG相当，但再次血运重建率较高。

Objective To compare the short- and long-term outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients with severe left ventricular dilatation （LVD）. Methods From July 2003 to September 2005, we enrolled 251 patients with severe LVD to undergo coronary revascularization with either PCI （ n = 101 ） or CABG （ n = 150 ） and analyzed the effects of different revaseularization strategies on the in-hospital and follow-up major adverse cardiovascular and cerebrovascular events （ MACCE ）. Results Compared with those in the CABG group, the patients in the PCI group had lower incidence of in-hospital MACCE events [ 3.0% （ 3/101 ） vsl0. 7% （ 16/150 ） , P = 0. 024 ], due mainly to a lower in-hospital mortality （ 2. 0% vs 8.7%, P = 0. 028 ）. Ninty-nine （ 98.0% ） patients in the PCI group and 136（90. 7% ） patients in the CABG group were followed up for （516 -＋ 182） days and （515 _＋ 231 ） days, respectively. Although no difference existed in the follow-up incidence of MACCE between two groups, the PCI patients had a trend of a higher incidence of MACCE events [ 18.2% （18/99） vs 9. 6% （13/136）,P= 0. 054], due mainly to a higher rate of repeat revascularization [ 14 （14. 1% ）vs（0.7% ）, P 〈 O. 01 ]. Two patients groups had the comparable follow-up rates of mortality [ 4 （4. 0% ） vs 12 （ 8. 8% ）, P = 0. 151 ], myocardial infarction [ 2 （2. 0% ） vs 1 （ 0. 7% ）, P = 0. 781 ] and stroke [ 2 （2. 0% ） vs 0 （0. 0% ）, P = 0. 176 ]. Conclusion For the patients with severe LVD. PCI is both safe and feasible. And it has a lower rate of in-hospital mortality, and a eomparable incidence of follow-up MACCE events. However, the rate of follow-up repeat revascularization is higher.