冠状动脉旁路移植术和药物支架植入术远期疗效的比较

Long-term outcomes of patients with angina after undergoing coronary artery bypass grafts or percutaneous coronary intervention

目的比较冠心病患者非药物治疗手段冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）术后的桥血管和支架的再通率。方法CABG术后和药物支架植入术后再次出现心绞痛症状的冠心病患者各40例，其年龄、性别、心肌梗死、高血压、高脂血症、心功能不全、脑卒中、药物治疗病史具有可比性。通过冠状动脉造影术比较两组患者的桥血管和药物支架的效率和寿命的远期效果。结果与行CABG患者的桥血管比较，行PCI患者的药物支架远期狭窄或者闭塞率降低34．3％。与行CABG患者的左乳内动脉（LIMA）桥血管比较，行PCI患者的左前降支的药物支架远期狭窄或者闭塞率降低14．8％。与行CABG患者的左回旋支和右冠状动脉静脉桥血管比较，行PCI患者的左回旋支以及右冠状动脉的药物支架远期狭窄或者闭塞率降低49．8％。结论冠状动脉药物支架植入术的远期通畅率较CABG明显增高，冠状动脉药物支架植入术的药物支架的效率和寿命要优于CABG的桥血管。

Objective To assess the long-term outcomes of patients with coronary atherosclerotic heart disease undergoing coronary artery bypass grafts （CABG） and percutaneous coronary intervention （PCI）. Methods Patients with coronary heart disease undergoing CABG or PCI and suffering angina again, were enrolled, with 40 in CABG group and PCI group respectively. Age, gender, myocardial infarction, hypertension, hyperlipidemia, heart failure, stroke and medicinal history were matched between two groups. The long-term efficiency was compared between the two groups by coronary angiography. Results Compared with CABG group, the long-term stenosis and blocking rate declined by 34.3% in PCI group. Compared with bypass artery of the left internal mammary artery of patients in CABG group, the long-term stenosis and blocking rate of the left anterior descending branches declined by 14.8% in PCI group. Compared with bypass vein of the left circumflex branches and the right coronary of patients in CABG group, the long-term stenosis and blocking rate of the left circumflex branches and the right coronary declined by 49.8% in PCI group. Conclusion The long-term revascularization rate is higher in PCI group than in CABG group. The drug stent in PCI is superior to bypass artery in CABG.