左主干及三支病变经皮冠状动脉介入与冠状动脉搭桥术后随访对比研究

Comparison of outcome in patients with three-vessel and/or left main disease undergoing percutaneous coronary intervention and coronary artery bypass graft surgery

目的总结比较冠心病（左主干和三支病变）患者接受经皮冠状动脉介入（PCI）或冠状动脉旁路移植术（CABG或者OPCAB）后的治疗效果。方法回顾性连续分析我院2009年9月到2012年9月期间行PCI或者CABG的左主干及三支病变患者，比较分析在住院期间、出院后12个月出现的终末事件，包括死亡、心肌梗死、心绞痛复发和再次介入等。结果共有1292例患者被纳入，分成PCI组626例，CABG组666例。随访12个月，90％的PCI和97％的CABG患者纳入。随访期间，PCI组死亡40例，CABG组死亡36例；心肌梗死PCI组36例，CABG组4例；再发心绞痛PCI组168例，CABG组18例；再干预PCI组134例，CABG组6例。心脑血管事件发生率CABG患者较PCI患者低（P〈0．05）。结论对三支和（或）左主干病变，CABG在减少不良心脑血管事件上优于PCI；但还需要更长期的随访研究。

Objective To compare the outcome including death, myocardial infarction, stroke, recurrent angina and need for re-intervention in patients with muhivessel disease undergoing pereutaneous intervention（PCI） or coronary artery bypass graft surgery（CABG）. Methods A retrospective and ongoing analysis of consecutive pa- tients with three-vessel disease and/or left main stem undergoing PCI or CABG between September 2009 and September 2012 was carried out. In-hospital outcome and outcome measures at 12 months, including death, my- ocardial infarction, cerebrovascular events, recurrent angina and re-intervention were recorded. Results A total of 1292 patients were identified： 626 PCI and 666 CABG. At 12 months, data were available for 90% of PCI and 97% of CABG patients. During the follow-up period, 40 patients died in PCI group, 36 cases in CABG group, 36 patients of myocardial infarction in PCI group, 4 cases in CABG group, 168 patients recurrent angina in PCI group, 18 cases in CABG group, 134 casesreintervented in PCI group, 6 cases in CABG group. Death, myocar- dial infarction or stroke were less frequent in CABG than in PCI patients（P=0.01 ）. Conclusion CABG is associ- ated with improved major adverse cardiovascular and cerebrovascular events in patients with three-vessel and/or left main stem disease compared with PCI at 12 months.