CABG对EDS孰优孰劣?——一项硬终点指标的长期随访研究

Long-Term Mortality Following Coronary Artery Bypass Graft Surgery and Stenting with Drug-eluting Stents

Chuntao Wu,Background: There are limited data on the difference in long-term survival between coronary artery bypass graft (CABG) surgery and stenting with drug-eluting stents (DES) in real-world practice. Earlier, we compared the difference in 18-month survival between the 2 procedures. In this study, we examined the difference in 5-year mortality.
Methods: The New York State’s Cardiac Surgery Reporting System and Percutaneous Coronary Intervention Reporting System were used to identify 13,296 CABG patients and 20,181 DES patients who had mutlivessel coronary disease and underwent procedures between October 1, 2003 and December 31, 2005, and the National Death Index was used to determine the vital status of these patients until the end of 2008. The CABG patients were then matched on a 1:1 ratio on the number of diseased vessels, the involvement diseased proximal left anterior descending (LAD) artery, and the propensity of receiving CABG surgery (instead of stenting). Kaplan-Meier survival analysis and Cox proportional hazards regression modeling were conducted to compare the risk of 5-year mortality between the two procedures.
Results: The propensity matching yielded 8,070 pairs of CABG and stent patients. The standardized differences in the distributions of all baseline risk factors were less than 3%, which indicates that all risk factors were well balanced. The 5-year Kaplan-Meier survival rates were 80.2% for CABG surgery and 72.9% for stenting (hazard ratio = 0.74, 95% confidence interval: 0.68 to 0.81, P<0.001). The hazard ratios were 0.65 (P<0.001) for patients with 3-vessel disease with proximal LAD artery disease, 0.76 (P<0.001) for 3-vessel disease with nonproxmial LAD artery disease, 0.67 (P<0.001) for patients with 2-vessel disease with proximal LAD artery disease, and 0.70 (P=0.005) for 2-vessel disease with nonproxmial LAD artery disease. There was no difference in risk of mortality between CABG surgery and stenting in patients with 2 diseased vessels without LAD artery disease (hazard ratio = 0.95, P=0.72). 
Conclusion: In mutlivessel coronary disease, CABG surgery is associated with lower risk of mortality in all patients except in patients without LAD artery disease


CABG
对EDS孰优孰劣?——一项硬终点指标的长期随访研究

来自同济大学附属第十人民医院ACC报道团队

 背景:评价冠状动脉旁路移植术(CABG)及药物洗脱支架植入术(DES)对冠心病患者长期生存率的影响目前尚缺乏数据支持。本届ACC中,吴春涛等报道了一项5年随访研究结果。

方法:根据纽约心脏外科手术报告系统和经皮冠状动脉介入报告系统纳入CABG患者13296例和DES患者20181,所有患者均为冠心病多支病变,手术时间从在2003.10.1.至2005.12.31.之间,同时根据全国死亡指数确定患者2008年底为止的生存状态,根据病变血管的数量,是否有LAD病变参按1:1比例进行配对,据患者行CABG的意向性选择行CABG或DES,采用 Kaplan-Meier生存分析和Cox比例风险回归模型比较两者5年死亡率。

结果:根据选择倾向性匹配产生进行CABG及DES的患者8070对,标准化后基线危险因素分布差异小于3%,从而排除相关危险因素的干扰。Kaplan-Meier分析表明CABG组对DES组5年生存率分别为80.2%VS72.9%(危险比= 0.74,95%可信区间:0.680.81,P <0.01)。冠心病三支病变伴LAD近端病变者风险比为0.65 (P<0.001),三支病变不伴前降支近端病变者风险比为0.76 (P<0.001),双支病变伴LAD近端病变者风险比为0.67(P <0.001),双支病变不伴LAD近端病变者风险比为0.70(p = 0.005),对冠心病双支病变不伴LAD病变者,CABG组与DES组比较死亡率无差异(风险比= 0.95,p = 0.72)。

结论:CABG能显著降低冠心病多支病变(其中一支是LAD)患者死亡率,对不变前降支病变者,CABG与DES相对获益无差别。


    2012/3/26 23:16:04     访问数:467
    转载请注明:内容转载自365医学网

大家都在说       发表留言

2012/3/27 17:48:51
梁治中:verygood
客服中心 4000680365  service@365yixue.com
编辑部   editor@365yixue.com

365医学网 版权所有 © 365heart All Rights Reserved.

京ICP备12009013号-1
京卫网审[2013]第0056号
京公网安备110106006462号
京ICP证041347号
互联网药品信息服务资格证书(京)-经营性-2018-0016  
搜专家
搜医院
搜会议
搜资源
 
先点击
再选择添加到主屏