冠心病不同血运重建方法的疗效观察

Efficacy of different revascularization methods in treatment of coronary heart disease

目的对比冠状动脉旁路移植术(CABG)和经皮冠状动脉介入治疗(PCI)两种血运重建方法治疗冠状动脉粥样硬化性心脏病(冠心病)的临床疗效。方法回顾性分析2012年3月~2014年4月于延安大学附属医院心内科进行治疗的冠心病患者300例的临床资料,其中男性168例,女性132例。按照手术方式不同分为CABG组(75例)和PCI组(225例)。术前造影检查冠状动脉受累情况、冠状动脉病变支数,记录住院期间死亡情况。术后6个月开始随访,记录主要不良心血管事件(MACE),随访2年。结果CABG组左主干、前降支及右冠状动脉病变比例均显著高于PCI组,差异具有统计学意义(P均<0.05)。CABG组单支病变、双支病变比例明显低于PCI组,2.67%vs.34.22%,2.67%vs.32.44%,差异具有统计学意义(P均<0.05)。CABG组三支病变比例为94.67%,明显高于PCI组的33.33%,差异具有统计学意义(P<0.05)。CABG组平均血管病变支数高于PCI组,[(2.47±0.76)支vs.(1.49±0.50)支],差异具有统计学意义(P<0.05)。共有273例患者成功随访,随访率91.00%,其中CABG组67例,共随访(23.67±5.76)个月,PCI组206例,共随访(23.89±6.23)个月。CABG组死亡、再发心肌梗死和心力衰竭入院比例与PCI组比较,差异无统计学意义(P均>0.05)。CABG组再次血运重建患者比例显著低于PCI组,1.49%vs.8.74%,差异具有统计学意义(P<0.05)。两组MACE总发生率比较,差异无统计学意义(P>0.05)。结论冠心病复杂病变预后改善首选冠状动脉旁路移植术,其再次血运重建率低于经皮冠状动脉介入治疗。

Objective To compare the clinical efficacy of two revascularization methods, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), in treatment of coronary heart disease (CHD).Methods The clinical data was retrospectively analyzed from CHD patients (n=300, male 168 and female 132) undergone treatment in the Department of Cardiology of Affiliated Hospital of Yan’an University from Mar. 2012 to Apr. 2014. All patients were divided into CABG group (n=75) and PCI group (n=225). The status of coronary artery lesions and number of lesion coronary vessel were examined with angiography before the operation, and death status was recorded during hospitalized period. The patients were followed up after the operation for 2 y for recording the incidence of major adverse cardiovascular events (MACE). Results The percentage of patients with lesions of left main coronary artery, anterior descending branch and right coronary artery was significantly higher in CABG group than that in PCI group (all P<0.05). The percentage of patients with 1-vessel lesion and 2-vessel lesion was significantly lower in CABG group than that in PCI group (2.67% vs. 34.22% and 2.67% vs. 32.44%, all P<0.05). The rate of patients with 3-vessel lesion was 94.67% in CABG group and 33.33% in PCI group (P<0.05).The number of lesion vessel was higher in CABG group than that in PCI group [(2.47±0.76) vs. (1.49±0.50),P<0.05]. There were totally 273 patients followed up successfully, and follow-up rate was 91.00%. There were 67 patients followed up for (23.67±5.76) m in CABG group and 206 followed up for (23.89±6.23) m in PCI group.The percentage of died patients and patients with recurrent myocardial infarction and heart failure had no statistical significance between 2 group (all P>0.05). The percentage of patients with re-revascularization was significantly lower in CABG group than that in PCI group (1.49% vs. 8.74%, P<0.05). The comparison in the total incidence of MACE had no statistical significance between 2 groups (P>0.05). Conclusion CABG is the first selection for improve prognosis in patients with CHD complicated lesions, and re-revascularization rate is lower in patients undergone CABG than that in ones undergone PCI.