冠状动脉旁路移植术与药物释放支架治疗左前降支近端单支血管病变的疗效对比  

Coronary artery bypass graft surgery versus drug-eluting stents for patients with isolated proximal left anterior descending disease

作　　者：高海涛 魏润生 陈晓伟 

机构地区：[1]唐山市工人医院心外2科,063000

出　　处：《中华胸心血管外科杂志》2016年第11期669-671,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的对比研究冠状动脉旁路移植术（CABG）和药物洗脱支架（DES）治疗冠状动脉左前降支近端（PLAD）单血管病变的治疗效果。方法收集2011年1月至2011年12月期间在我院接受治疗的286例冠状动脉PLAD单血管病变患者病历资料。根据治疗方法不同，分为DES组和CABG组，每组143例。统计出院患者病死率和因心肌梗死（MI）／卒中而再次人院治疗的患者比例，对治疗后恢复情况进行比较。结果两组患者的全因病死率和MI／卒中病死率相比，差异无统计学意义（P〉0．05）。CABG手术患者再次血运重建率较低（7．09％对12．98％，P=0．0007）。使用Cox比例风险模型进一步调整，术后3年的全因病死率（CABG／DES的校正风险比：1．14，95％CI：0．70-1．85）和MI／卒中病死率（校正风险比=1．15，95％CI：0．76—1．73）差异均无统计学意义（P〉0．05）；CABG组患者的再次血运重建率仍然显著降低（校正风险比=0．54，95％CI：0．36～0．81）。结论PLAD单血管病变患者接受CABG的再次血运重建率明显降低。与DES相比，二者术后3年的全因病死率以及ML／卒中病死率无明显差异．Objective To compare outcomes in patients with proximal left anterior descending（PLAD） who underwent coronary artery bypass graft（CABG） and percutaneous coronary interventions（PCI） with drug-eluting stents（DES）. Methods Between January and December in 2011, 286 PLAD patients were treated with CABG and DES. 143 patients received DES treatment（DES group） , 143 patients underwent CABG surgery（ CABG group）. The mortality of patients after discharge from hospital, and the proportion of patients who were treated by myocardial infarction（MI） and stroke were detelwnined. Results Kaplan-Meier estimates for CABG and DES did not significantly differ for all-cause mortality or mortality of MI and/or stroke, but repeat revascularization rates were lower for CABG（7.09% vs. 12.98 %, P = 0. 0007 ）. After further adjustment with Cox proportional hazards models, there were still no significant differences in 3-year all-cause mortality rates （ CABG and/or DES AHR = 1.14, 95% CI： 0. 70 - 1.85 ） , and mortality of MI and/or stroke rates （ AHR = 1.15, 95 % CI：0. 76 - 1.73 ） , P 〉 0.05. The repeat revascularization rate remained significantly lower for CABG patients（AHR = 0.54, 95% CI： 0. 364）. 81 ）. Conclusion Despite the higher rating in current guidelines of CABG for patients with isolated PLAD disease, there were no differences in 3-year all-cause mortality or mortality of MI and/or stroke. CABG patients had significantly lower repeat revascularization rates.

关 键 词：冠状动脉旁路移植术 支架 冠状动脉狭窄 左前降支近端病变 

分 类 号：R654.2[医药卫生—外科学]