稳定型冠心病不同治疗方法的预后比较  

The comparison of different therapies for the treatment of stable coronary artery disease

作　　者：黄政[1] 蒋廷波[2] 程久佩 

机构地区：[1]安徽省宣城市人民医院心内科,242000 [2]苏州大学附属第一医院心内科,215006

出　　处：《疑难病杂志》2011年第3期168-170,共3页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的比较稳定型冠心病单纯药物治疗、经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)3种治疗方法的远期预后。方法将317例稳定型冠心病患者按治疗方法不同分为单纯药物治疗组、PCI组和CABG组,每组再按冠状动脉病变情况分为单支病变和多支病变2个亚组。平均随访(48±8)个月,随访内容包括全因死亡、心肌梗死、血管重建、因急性冠脉综合征(ACS)再入院以及心绞痛缓解情况。结果无论单支病变或是多支病变,单纯药物治疗组心绞痛缓解率、全因死亡、心肌梗死、因ACS再入院与PCI组比较差异均无统计学意义(P>0.05);对于多支病变患者,CABG组心绞痛缓解率高于药物治疗组和PCI组(P<0.05或P<0.01),全因死亡、血管重建率显著低于药物治疗组和PCI组(P<0.01或P<0.05),PCI组血管重建率低于药物治疗组(P<0.05)。结论强化药物治疗是稳定型冠心病治疗的基础;早期PCI可能并不改善稳定型冠心病患者的远期预后;对于多支病变稳定型冠心病患者,CABG预后可能优于PCI。Objective To compare the long term prognosis of different therapies for the treatment of stable coronary artery disease.Methods 317 stable coronary artery disease patients were divided into three groups;medical therapy group, percutaneous coronary intervention（PCI） group and coronary artery bypass grafting（CABG） group.Each group was further divided into two sub-groups,including single vessel stenosis and multi-vessel stenosis according to the number of coronary artery stenosis.The patients were followed up for average（48±8） months.The clinical endpoint including death,myocardial infarction, revascularization,readmission caused by acute coronary syndrome（ACS） and release of angina pectoris.Results During the follow up,there were no significant differences between medical therapy group and PCI group no matter single or multiple vessel stenosis in angina pectoris releave rate,the endpoint of death,myocardial infarction and readmission because of ACS（P0.05）.In multiple vessel stenosis sub-group,CABG group had a significant higher rate in angina pectoris releave rate,lower rate in death and revascularization than that in medical therapy group and PCI group（P0.01 or P0.05）;PCI group had a significant lower rate of revascularization than that in medical therapy group（P0.05 ）.Conclusion Medical therapy is the basic treatment of stable coronary disease.PCI in early stage may not improve long term prognosis in patients with stable coronary artery disease;CABG may had a better prognosis than PCI in multiple vessel stenosis.

关 键 词：冠心病 稳定型 经皮冠状动脉介入治疗 冠状动脉旁路移植术 预后 

分 类 号：R541.4[医药卫生—心血管疾病]