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左主干病变PCI和CABG术后5年预后分析
作者:小柯机器人 发布时间:2019/9/29 9:50:02

近日,美国西奈山伊坎医学院Gregg W. Stone及其小组研究了左主干病变患者行PCI或CABG术后5年的疗效。相关论文2019年9月28日在线发表在《新英格兰医学杂志》上。

对于左主干病变患者,与冠状动脉旁路移植术(CABG)相比,现代药物洗脱支架经皮冠状动脉介入治疗(PCI)的长期预后尚不明确。

研究组招募了1905名左主干冠脉疾病的患者,将其随机分组,其中948例接受含氟聚合物钴-铬-依维莫司洗脱支架PCI术,957例接受CABG术。

术后5年,PCI组中有22.0%的患者发生死亡、中风或心肌梗死,CABG组有19.2%。PCI组的全因死亡率为13.0%,显著高于CABG组(9.9%)。PCI组和CABG组中明确的心血管死亡的发生率分别为5.0%和4.5%,心肌梗死发生率分别为10.6%和9.1%,差异均不显著。PCI组脑血管事件的发生率为3.3%,显著低于CABG组(5.2%),但两组间卒中发生率分别为2.9%和3.7%,差异并不显著。PCI术后缺血驱动的血管重建发生率为16.9%,显著高于CABG组。

总之,对于解剖结构中低复杂度的左主干冠脉病变患者,PCI和CABG的5年死亡、中风和心肌梗死的综合预后率无显著差异。

附:英文原文

Title: Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease

Author: Gregg W. Stone, A. Pieter Kappetein, Joseph F. Sabik, Stuart J. Pocock, Marie-Claude Morice, John Puskas, David E. Kandzari, Dimitri Karmpaliotis, W. Morris Brown III, Nicholas J. Lembo, Adrian Banning, Béla Merkely, Ferenc Horkay, Piet W. Boonstra, Ad J. van Boven, Imre Ungi, Gabor Bogáts, Samer Mansour, Nicolas Noiseux, Manel Sabaté, Jose Pomar, Mark Hickey, Anthony Gershlick, Pawel E. Buszman, Andrzej Bochenek, Erick Schampaert, Pierre Pagé, Rodrigo Modolo, John Gregson, Charles A. Simonton, Roxana Mehran, Ioanna Kosmidou, Philippe Généreux, Aaron Crowley, Ovidiu Dressler, Patrick W. Serruys

Issue&Volume: 2019-09-28

Abstract:

BACKGROUND
Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established.

METHODS
We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt–chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction.

RESULTS
At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], −0.9 to 6.5; P=0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, −1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, −1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, −1.9 percentage points; 95% CI, −3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, −0.8 percentage points; 95% CI, −2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0).

CONCLUSIONS
In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. 

DOI: 10.1056/NEJMoa1909406

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1909406

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home