左心室功能不全冠心病患者支架术与冠状动脉旁路移植术的对比研究  

Comparison of coronary stenting and bypass grafting in patients of left ventricular dysfunction with coronary artery disease.

作　　者：阙斌[1] 李志忠[1] 张京梅[1] 王苏[1] 陶英[1] 来勇强[1] 张红[1] 孙涛[1] 赵战勇[1] 阴桢茜[1] 李昭[1] 

机构地区：[1]首都医科大学附属北京安贞医院抢救中心15病房,100029

出　　处：《中国综合临床》2009年第3期231-234,共4页Clinical Medicine of China

摘　　要：目的比较左心室功能不全的冠心病患者经皮冠状动脉介入治疗（PCI）支架术与冠状动脉旁路移植术（CABG）对住院与临床随访结果的影响。方法147例左心室功能不全的冠心病患者，根据血运重建方式的不同将其分为PCI组（60例）和CABG组（87例），记录其临床与冠状动脉造影特征、血运重建情况和住院临床结果等资料，并进行临床随访。主要观察终点为住院与随访主要不良心脑血管事件（MACCE）（包括全因死亡、新发心肌梗死、卒中和再次血运重建）。所有资料采用SPSS13．0软件进行统计分析，以P〈0．05为差异有统计学意义。结果PCI组和CABG组相比，院内MACCE发生率差异无统计学意义（1．7％与9．2％，P〉0．05）；院内病死率差异无统计学意义（1．7％与8．0％，P〉0．05）。多因素Logistic回归分析表明，院内MACCE风险相当（OR=3．03，95％CI0．27～34．48，P〉0．05）。平均随访22个月（中位数时间668d）显示，2组MACCE发生率差异无统计学意义（16．0％与13．8％，P〉0．05），再次血运重建差异均无统计学意义（8．0％与1．7％，P〉0．05）。多因素Cox回归分析显示，2组随访MACCE风险基本相当（HR=1．35，95％CI 0．44～4．13，P〉0．05）。结论合并左心室功能不全的冠心病患者，PCI支架术与CABG的住院及随访MACCE发生率均相当。随着药物洗脱支架的广泛应用，PCI术的远期效果有望进一步提高。Objective To compare the in-hospital and follow-up clinical results of percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） in patients of left ventricular dysfunction with coronary artery disease. Methods 147 patients with left ventricular dysfunction were divided into PCI group （n = 60） and CABG group（ n = 87）. Clinical, angiographic and revascularization data were collected for analysis. Patients were followed up. The primary endpoint was in-hospital, major adverse cardiovascular and cerebral events （ MACCE, including all-cause death, newly-onset myocardial infarction, stroke and repeated revascularization）. Data were analyzed by SPSS 13.0 software. P value of less than 0. 05 was considered statistically significant. Results In-hospital MACCE rates and mortality of the two groups were comparable [ （6.7% vs 9.2%, P 〉 0.05 ）and （1.7% vs 8.0%, P 〉 0.05） ]. Multivariate Logistic regression analysis indicated that in-hospital MACCE risk of the two groups were similar （ OR ≥ 3.03,95 % CI 0. 27 - 34.48, P 〉 0. 05 ）. 22-month follow-up showed no signficance in MACCE rates （ 16.0% vs 13.8 %, P 〉 0. 05 ） and in repeated revascularization rates （8.0% vs 1.7 %, P 〉 0.05 ） between the two groups. Multivariate Cox regression analysis indicated that follow-up MACCE risk of the two groups were comparable （ HR ≥ 1.35,95 % CI 0. 44 - 4.13, P 〉 0. 05 ）. Conclusion In coronary artery disease patients with left ventricular dysfunction, PCI and CABG have similar in-hospital and long-term MACCE rates. Long-term effect of PCI would be further increased with the wide use of drug-eluting stents.

关 键 词：冠状动脉支架术 冠状动脉旁路移植术 左心室功能不全 预后 

分 类 号：R654.2[医药卫生—外科学] R541.4[医药卫生—临床医学]