PCI和CABG治疗无保护左主干开口/体部病变的远期预后比较

Long-term outcome comparison of ostial/shaft lesions in unprotected left main coronary artery treated by PCI or CABG

目的比较无保护左主干开口/体部病变患者接受经皮冠状动脉介入术(PCI)或冠状动脉旁路移植术(CABG)的长期预后。方法入选2003年1月至2009年7月于北京安贞医院行PCI(置入药物洗脱支架)或CABG治疗的无保护左主干开口/体部病变患者259例。通过门诊或电话对纳入患者进行长期随访。研究终点包括全因死亡、心肌梗死、卒中和再次血运重建。采用Kaplan-Meier法描述两组患者终点事件的累积发生率,log-rank检验生存率差异有无统计学意义。Cox比例风险模型分析PCI/CABG对远期预后的影响是否存在差异。结果共纳入259例患者,其中PCI组149例,CABG组110例。男性193例(74.5%),年龄为(61.4±9.8)岁。随访时间为10.1(8.3,11.2)年,完成随访234例(90.3%)。据Kaplan-Meier法描述的各事件累积发生率,PCI组和CABG组的全因死亡[37.0%比43.1%,P=0.143]、心肌梗死[34.0%比19.4%,P=0.866]、卒中[6.4%比11.7%,P=0.732)和再次血运重建发生率(33.6%比39.9%,P=0.522)差异均无统计学意义,校正年龄、左心室射血分数、血肌酐等因素后结果仍显示两组的全因死亡、心肌梗死、卒中及再次血运重建发生率差异均无统计学意义(P均>0.05)。结论无保护左主干开口/体部病变患者置入药物洗脱支架的长期预后与CABG相当。

Objective To evaluate long-term clinical outcomes of consecutive patients treated with coronary artery bypass grafting(CABG)and percutaneous coronary intervention(PCI)with drug-eluting stents(DES)for ostial/shaft lesions in unprotected left main coronary artery(ULMCA).Method A total of 259 patients with isolated ostial/midshaft lesions in unprotected left main coronary artery were enrolled consecutively who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital.The endpoints of the study were death,repeat revascularization,myocardial infarction(MI)and stroke.Time to the primary endpoint was evaluated according to the Kaplan-Meier method,and the log-rank test was applied to compare the incidence of the endpoint.Adjusted risks for adverse outcomes were compared by multivariate Cox proportional hazard regression analyses.Results A total of 259 patients were included,including 149 in PCI group and 110 in CABG group.And 193(74.5%)cases were males.The age was(61.4±9.8)years old.The median follow-up was 10.1 years(interquartile range 8.3 to 11.2 years)in the overall patients.There were no significant difference for the incidence of death[37.0%vs.43.1%,P=0.143],MI[34.0%vs.19.4%,P=0.866],stroke[6.4%vs.11.7%,P=0.732],repeart revascularization[33.6%vs.39.9%,P=0.522]between PCI group and CABG group before multivariate adjusting,according to the incidence calculated with Kaplan-Meier.After adjusting covariates such as age,left ventricular ejection fraction(LVEF)and serum creatine with multivariate Cox hazard regression model,there was still no significant difference between the two groups.Conclusions PCI with DES is as effective and safe as CABG in patients with left main ostium/shaft lesion during a median follow-up of 10.1 years.