单纯前降支病变机器人冠脉旁路移植术与药物洗脱支架的远期疗效对比  

Long-term outcomes of robotically assisted coronary artery bypass graft surgery versus drug eluting stent in patients with isolated left anterior descending disease

作　　者：李双磊[1] 陈韵岱[2] 高长青[1] 

机构地区：[1]解放军总医院心血管外科,北京1008531 [2]解放军总医院心血管内科,北京1008531

出　　处：《解放军医学院学报》2017年第6期500-504,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家高技术研究发展计划(863计划)(2012AA021104)~~

摘　　要：目的分析比较行药物洗脱支架(drug eluting stent,DES)与机器人冠脉旁路移植术(robotically assisted coronary artery bypass graft,R-CABG)对单纯前降支病变(isolated left anterior descending disease,i LAD)的远期疗效。方法采集2007年4月-2014年11月在我院行R-CABG的223例患者及2011年4月-2014年11月在我院行前降支DES治疗的4 047例患者信息,共筛选符合条件的DES患者496例,R-CABG患者108例。筛选后根据重点基线数据进行倾向评分匹配(propensity score matching,PSM),匹配后共纳入216例患者(DES 108例,R-CABG 108例)。对其进行随访,对比两组的死亡率、心梗发生率、脑卒中发生率、再次再血管化(repeat target lesion revascularization,r-TLR)发生率、主要不良心血脑管事件(main adverse cardiac and cerebral events,MACCE)及心绞痛缓解情况。结果两组患者死亡率、心梗发生率、脑卒中发生率及MACCE发生率无统计学差异(P>0.05);而DES组r-TLR发生率高于R-CABG组(6.48%vs 0.93%,P=0.033 9)。DES组与R-CABG组相比有较高的心绞痛再发率(27.78%vs 8.33%,P=0.000 4)及术后心律失常发生率(9.26%vs 1.85%,P=0.020 9)。结论接受R-CABG与DES的i LAD患者死亡率、心梗发生率、脑卒中发生率及MACCE发生率无统计学差异,但R-CABG患者r-TLR免除率及心绞痛缓解效果优于DES患者。Objective To compare the long-term outcomes of robotically assisted coronary artery bypass graft （R-CABG） versus percutaneous coronary intervention （PCI） with drug eluting stents （DES） for patients with isolated left anterior descending disease（iLAD）. Methods Clinical data were collected in 223 patients who underwent R-CABG in our hospital from April, 2007 to November, 2014. Cardiology Database System of our hospital was used to identify 4 047 patients who underwent PCI with DES for LAD lesion from April, 2011 to November, 2014. Total of 496 patients received DES and 108 patients underwent R-CABG were screened out. Patients were matched into 108 R-CABG and DES pairs by propensity score according to vital statistics. Mortality, incidence of myocardial infarction（MI）, stroke, repeat target lesion revascularization（r-TLR）, main adverse cardiac and cerebral events（MACCE） and angina relief were compared across pairs. Results Kaplan-Meier estimates for R-CABG and DES had no significant difference in mortality （P=I.000）, incidence of MI （P=0.317 3）, Stroke （P=0.796 3） and MACCE （P=0.465 2）, but the rate of r-TLR （P=0.033 9） was lower in R-CABG group. Patients in R-CABG group had lower rates of arrhythmia （P=0.016 0） and recurrent angina （P=0.020 9） after operation compared with patients in DES group. Conclusion Although R-CABG patients had lower r-TLR rate and better angina relief compared with DES patients, there were no difference in mortality, occurence of MI, stroke, and MACCE between them.

关 键 词：前降支近端病变 药物洗脱支架 机器人 倾向评分匹配 

分 类 号：R541.4[医药卫生—心血管疾病] TP242[医药卫生—内科学]