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目的:对比雷帕霉素洗脱支架(SES)置入与冠状动脉旁路移植术(CABG)的近期与中期临床疗效。方法:单中心回顾性连续入选2003年7月～2004年6月期间行择期血运重建的多支冠状动脉病变患者,分为CABG组(811例),SES组(251例)。随访终点事件包括死亡、心肌梗死、脑卒中和再次血运重建等主要不良心脑血管事件(MACCE)。采用Kaplan-Meier方法估计无事件生存率。采用Logistic多元回归方法调整分析治疗对终点事件的相对影响。结果:随访率90.3%。中位随访时间19个月。随访30d,CABG组MACCE的发生率高于SES组(5.4%∶1.6%,OR3.66,95%CI1.26～10.61),CABG组的病死率高于SES组(4.6%∶1.2%,OR4.02,95%CI1.18～13.74)。至随访结束,SES组累积病死率低于CABG组(3.1%∶7.6%,OR0.44,95%CI0.19～0.99),但再次血运重建率高于CABG组(8.4%∶1.5%,OR6.83,95%CI3.07～15.19),MACCE2组间差异无统计学意义。以30d为分期分析,CABG组30d生存率低于SES组(95.4%∶98.8%,P<0.05),2组30d后生存率差异无统计学意义(97.2%∶98.3%,P>0.05)。结论:多支冠状动脉病变CABG与SES置入比较,CABG的30d病死率高于SES置入,30d后病死率差异无统计学意义;多支冠状动脉SES置入的中期血运重建率高于CABG。
Objective: To compare the short-term and mid-term clinical efficacy of rapamycin eluting stent (SES) with coronary artery bypass grafting (CABG). Methods: A single center was retrospectively enrolled in this study. Patients with multi-vessel coronary artery disease undergoing elective elective revascularization from July 2003 to June 2004 were divided into CABG group (811 cases) and SES group (251 cases). Follow-up end points included major adverse cardiac and cardiovascular events (MACCE) such as death, myocardial infarction, stroke, and revascularization. Kaplan-Meier method was used to estimate event-free survival. Logistic multiple regression analysis was used to adjust the relative impact of treatment on endpoint events. Results: The follow-up rate was 90.3%. The median follow-up time was 19 months. At 30 days of follow-up, the incidence of MACCE in CABG group was higher than that in SES group (5.4% vs 1.6%, OR 3.6%, 95% CI 1.26-10.61). The mortality rate in CABG group was higher than that in SES group (4.6% vs 1.2% .02, 95% CI 1.18 ~ 13.74). At the end of follow-up, the cumulative mortality in SES group was lower than that in CABG group (3.1% vs 7.6%, OR 0.44, 95% CI 0.19-0.99), but the rate of revascularization again was higher than that in CABG group (8.4% vs 1.5% OR6.83,95% CI3.07 ~ 15.19), there was no significant difference between MACCE2 groups. At 30 days, the 30-day survival rate in CABG group was lower than that in SES group (95.4% vs 98.8%, P <0.05). There was no significant difference in survival rate between the two groups after 30 days (97.2% vs 98.3%, P> 0.05). CONCLUSIONS: The multi-branched coronary artery lesions CABG compared with SES implantation, CABG 30d mortality was higher than that of SES implantation, 30d after the mortality was no significant difference; multi-branch coronary artery SES midrift revascularization rate was higher than CABG.