CAJ | 학술논문

目的对比经皮冠状动脉介入术(PCI)和冠状动脉旁路移植术(CABG)治疗无保护左主干病变的长期预后.方法入选2003年1月至2009年7月北京安贞医院行PCI或CABG治疗的无保护左主干病变患者922例(465例行PCI置入药物洗脱支架,457例行CABG),研究终点包括全因死亡、心原性死亡、心肌梗死、再次血运重建、卒中、心原性死亡死亡/心肌梗死/卒中联合硬终点以及主要不良心脑血管事件(MACCE,包括心原性死亡、非致命性心肌梗死、卒中及再次血运重建的联合终点).Cox比例风险模型用以计算风险比(HR)及95％CI,进行多因素分析.结果随访时间7.1(5.3,8.2)年,校正前PCI组和CABG组间不良事件发生率:全因死亡[13.0％ (41/465)比22.1％(72/457),P=0.027]、卒中[5.8％ (11/465)比18.9％ (46/457),P＜0.001]、心原性死亡/心肌梗死/卒中[19.9％ (58/465)比30.4％(101/457),P=0.009]、再次血运重建[32.3％(110/465)比19.2％(58/457),P＜0.001]的发生率差异有统计学意义;心原性死亡[7.3％ (26/465)比10.1％ (43/457),P =0.059]、心肌梗死[13.9％ (33/465)比6.7％ (26/457),P=0.196]、MACCE [42.9％(145/465)比42.5％(142/457),P=0.122]发生率差异无统计学意义.多因素校正后PCI组MACCE发生率明显高于CABG组(P =0.009),主要归因于PCI组较CABG显著升高的再次血运重建发生率(P＜0.001);两组间全因死亡(P=0.112)、心原性死亡(P=0.594)及心原性死亡/心肌梗死/卒中联合硬终点发生率(P =0.309)差异均无统计学意义,CABG组卒中发生率明显高于PCI组(P =0.001).结论 CABG和PCI治疗无保护左主干病变患者的长期生存率相似,PCI组再次血运重建明显升高,而CABG组卒中发生率明显升高.
목적 대비경피관상동맥개입술(PCI)화관상동맥방로이식술(CABG)치료무보호좌주간병변적장기예후.방법 입선2003년1월지2009년7월북경안정의원행PCI혹CABG치료적무보호좌주간병변환자922례(465례행PCI치입약물세탈지가,457례행CABG),연구종점포괄전인사망、심원성사망、심기경사、재차혈운중건、졸중、심원성사망사망/심기경사/졸중연합경종점이급주요불양심뇌혈관사건(MACCE,포괄심원성사망、비치명성심기경사、졸중급재차혈운중건적연합종점).Cox비례풍험모형용이계산풍험비(HR)급95％CI,진행다인소분석.결과 수방시간7.1(5.3,8.2)년,교정전PCI조화CABG조간불량사건발생솔:전인사망[13.0％ (41/465)비22.1％(72/457),P=0.027]、졸중[5.8％ (11/465)비18.9％ (46/457),P＜0.001]、심원성사망/심기경사/졸중[19.9％ (58/465)비30.4％(101/457),P=0.009]、재차혈운중건[32.3％(110/465)비19.2％(58/457),P＜0.001]적발생솔차이유통계학의의;심원성사망[7.3％ (26/465)비10.1％ (43/457),P =0.059]、심기경사[13.9％ (33/465)비6.7％ (26/457),P=0.196]、MACCE [42.9％(145/465)비42.5％(142/457),P=0.122]발생솔차이무통계학의의.다인소교정후PCI조MACCE발생솔명현고우CABG조(P =0.009),주요귀인우PCI조교CABG현저승고적재차혈운중건발생솔(P＜0.001);량조간전인사망(P=0.112)、심원성사망(P=0.594)급심원성사망/심기경사/졸중연합경종점발생솔(P =0.309)차이균무통계학의의,CABG조졸중발생솔명현고우PCI조(P =0.001).결론 CABG화PCI치료무보호좌주간병변환자적장기생존솔상사,PCI조재차혈운중건명현승고,이CABG조졸중발생솔명현승고.
Objective To compare the long-term real-world outcomes of consecutive patients with unprotected left main coronary artery disease (ULMCA) underwent percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG).Methods Consecutive patients with ULMCA (defined as stenosis≥50％) undergoing DES implantation or CABG between January 2003 to July 2009 in Beijing Anzhen Hospital were enrolled.The follow-up period extended through August 2013.The end points of the study were death,cardiac death,repeat revascularization,myocardial infarction (MI),stroke,the composite of cardiac death,MI or stroke and MACCE (major adverse cardiac and cerebrovascular events,the composite of cardiac death,MI,stroke or repeat revascularization).Results From January 2003 to July 2009,922 ULMCA patients were enrolled in this study (465 PCI patients,and 457 CABG patients).The median follow-up was 7.1 years (interquartile range 5.3 to 8.2 years).The crude relative risk was as follows:overall death rate (13.0％ (41/465) vs.22.1％ (72/457),P =0.009),stroke rate (5.8％ (11/465) vs.CABG 18.9％ (46/457),P ＜ 0.001) were significantly lower whereas the rate of repeat revascularization (32.3％ (110/465) vs.CABG 19.2％ (58/457),P ＜0.001) was significantly higher in PCI group than in CABG group.MI rate was similar between PCI and CABG group (13.9％ (33/465) vs.6.7％ (26/457),P =0.196).MACCE rate was also similar between the 2 groups (42.9％ (145/465) vs.42.5％ (142/457),P =0.122).After multivariate adjusting,there was no significant difference in rates of death,MI and a composite of serious outcomes (cardiac death,MI,or stroke) between the 2 groups.Rates of MACCE were significantly higher in the PCI group (P =0.009) due to increased rate of repeat revascularization (P ＜0.001).However,stroke rate was still significantly higher in CABG group (P =0.001) after multivariate adjusting.Conclusion During a follow-up up to 8.2 years,the survival rate is similar between the PCI and the CABG group in patients with ULMCA disease.The rate of repeat revascularization is significantly higher and stroke rate is significantly lower in the PCI group compared to CABG group.