中华临床医师杂志(电子版)
中華臨床醫師雜誌(電子版)
중화림상의사잡지(전자판)
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
15期
2832-2835
,共4页
李贵才%刘宇%宋士秋
李貴纔%劉宇%宋士鞦
리귀재%류우%송사추
冠心病%血管成形术,经腔,经皮冠状动脉%冠状动脉旁路移植术,非体外循环%多支血管病变
冠心病%血管成形術,經腔,經皮冠狀動脈%冠狀動脈徬路移植術,非體外循環%多支血管病變
관심병%혈관성형술,경강,경피관상동맥%관상동맥방로이식술,비체외순배%다지혈관병변
Coronary artery disease%Angioplasty,transluminal,percutaneous coronary%Coronary artery bypass,off-pump%Multivessel disease
目的:对比经皮冠状动脉血管成形术(PCI)和冠状动脉旁路移植术(CABG)两种不同再血管化方式对合并心功能不全的多支冠状动脉血管病变的患者近、远期预后的效果。方法我院2012年1月至2014年1月进行PCI和CABG治疗的多支血管病变患者255例。所有患者入院后行冠状动脉造影检查,由资深心脏介入医师根据患者影像学和临床基线特征决定PCI或CABG治疗。根据不同的再血管化方式分为PCI组(n=190)和CABG组(n=65)。对患者进行院内以及术后3个月随访,主要终点(MACE):死亡、非致命性心肌梗死、靶病变血运重建。比较两组主要终点事件发生率。结果CABG组SYNTAX积分显著高于PCI组(34.1±8.2vs.24.1±8.1,P<0.05)。临床随访结果显示,住院期间CABG死亡率显著高于PCI组(6.1%vs.1.6%,P<0.05),主要心脏不良事件CABG组显著高于PCI组(9.2%vs.3.2%,P<0.05)。3个月CABG死亡率虽然仍高于PCI组(7.7%vs.3.2%,P<0.05),血运重建率PCI组显著高于CABG组(16.3%vs.1.8%,P<0.05),主要心脏不良事件两组相当无显著性差异(12.3%vs.11.1%,P>0.05)。结论多支血管病变PCI可提供良好的近期疗效,CABG近期效果较PCI差,但远期效果较好,存活患者血运重建率低。
目的:對比經皮冠狀動脈血管成形術(PCI)和冠狀動脈徬路移植術(CABG)兩種不同再血管化方式對閤併心功能不全的多支冠狀動脈血管病變的患者近、遠期預後的效果。方法我院2012年1月至2014年1月進行PCI和CABG治療的多支血管病變患者255例。所有患者入院後行冠狀動脈造影檢查,由資深心髒介入醫師根據患者影像學和臨床基線特徵決定PCI或CABG治療。根據不同的再血管化方式分為PCI組(n=190)和CABG組(n=65)。對患者進行院內以及術後3箇月隨訪,主要終點(MACE):死亡、非緻命性心肌梗死、靶病變血運重建。比較兩組主要終點事件髮生率。結果CABG組SYNTAX積分顯著高于PCI組(34.1±8.2vs.24.1±8.1,P<0.05)。臨床隨訪結果顯示,住院期間CABG死亡率顯著高于PCI組(6.1%vs.1.6%,P<0.05),主要心髒不良事件CABG組顯著高于PCI組(9.2%vs.3.2%,P<0.05)。3箇月CABG死亡率雖然仍高于PCI組(7.7%vs.3.2%,P<0.05),血運重建率PCI組顯著高于CABG組(16.3%vs.1.8%,P<0.05),主要心髒不良事件兩組相噹無顯著性差異(12.3%vs.11.1%,P>0.05)。結論多支血管病變PCI可提供良好的近期療效,CABG近期效果較PCI差,但遠期效果較好,存活患者血運重建率低。
목적:대비경피관상동맥혈관성형술(PCI)화관상동맥방로이식술(CABG)량충불동재혈관화방식대합병심공능불전적다지관상동맥혈관병변적환자근、원기예후적효과。방법아원2012년1월지2014년1월진행PCI화CABG치료적다지혈관병변환자255례。소유환자입원후행관상동맥조영검사,유자심심장개입의사근거환자영상학화림상기선특정결정PCI혹CABG치료。근거불동적재혈관화방식분위PCI조(n=190)화CABG조(n=65)。대환자진행원내이급술후3개월수방,주요종점(MACE):사망、비치명성심기경사、파병변혈운중건。비교량조주요종점사건발생솔。결과CABG조SYNTAX적분현저고우PCI조(34.1±8.2vs.24.1±8.1,P<0.05)。림상수방결과현시,주원기간CABG사망솔현저고우PCI조(6.1%vs.1.6%,P<0.05),주요심장불량사건CABG조현저고우PCI조(9.2%vs.3.2%,P<0.05)。3개월CABG사망솔수연잉고우PCI조(7.7%vs.3.2%,P<0.05),혈운중건솔PCI조현저고우CABG조(16.3%vs.1.8%,P<0.05),주요심장불량사건량조상당무현저성차이(12.3%vs.11.1%,P>0.05)。결론다지혈관병변PCI가제공량호적근기료효,CABG근기효과교PCI차,단원기효과교호,존활환자혈운중건솔저。
ObjectiveThis study was designed to compare the efficacy between primary PCI and surgical coronary artery bypass graft (CABG) for patients with heart failure presented with multi-vessel disease.MethodsA total of 255 consecutive patients from Jan. 2012 to Jan. 2014 with heart failure. All cases were performed coronary angiography which confirmed existence of multi-vessel coronary disease. They were divided into two groups according to different therapeutic strategy. Primary PCI group enroled 190 cases and 65 in CABG group. Clinical and angiographic features as baseline and in-hospital outcomes were compared. The primary endpoints analysis included the in-hospital and 3-months rates of major adverse cardiac events (MACE) and its components, death, reinfarction, ischemia driven target and vessel revascularization, and stroke.ResultsIn the CABG group (n=190), there were more cases with lung infection, renal dysfunction. Angiographic features combined with more 3 vessel disease and left main trunk involvement. The score of SYNTAX in CABG was higher than PCI group (34.1±8.2vs. 24.1±8.1,P<0.05). The CABG group had the significant longer stay in hospital. In-hospital mortality (6.1%vs. 1.6%,P<0.05) and MACE (9.2%vs. 3.2%,P<0.05) in CABG group was significant higher than PCI group. 3-month folow-up showed that mortality was stil higher in CABG group than in PCI group (7.7%vs. 3.2%,P<0.05), but MACE was comparable in both groups (12.3%vs. 11.1%, P>0.05). Revascularization rate was significant higher in PCI group than in CABG group (16.3%vs. 1.8%, P<0.05).ConclusionFor patients with heart failure presented with multivessel disease primary stent implantation provides both short-and long term safety. CABG provides good long-term but not short-term outcome. Survival has the low rate of revascularization in CABG group.