Ten-Year Follow-Up Survival of the Medicine, Angioplasty, or Surgery Study (MASS II) A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease
Ten-Year Follow-Up Survival of the Medicine, Angioplasty, or Surgery Study (MASS II) A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease
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DOI：
10.1161/circulationaha.109.911669
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发表时间：
2010-09-07
期刊：
影响因子：
37.8
通讯作者：
Ramires, Jose A. F.
中科院分区：
文献类型：
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作者：
Hueb, Whady;Lopes, Neuza;Ramires, Jose A. F.
背景：本研究比较了经皮冠状动脉介入治疗(PCI)、冠状动脉手术(CABG)和内科治疗(MT)对多支冠状动脉病变、稳定型心绞痛和心功能保留患者的10年随访情况。方法和结果：主要终点是总死亡率、Q波心肌梗死或需要血运重建的顽固性心绞痛。所有资料均按意向处理原则进行分析。在同一机构，611名患者被随机分配到冠状动脉搭桥术(n=203)、经皮冠状动脉成形术(n=205)或移植组(n=203)。10年生存率分别为74.9%、75.1%和69%(P=0.089)。冠状动脉旁路移植术、经皮冠状动脉介入术和移植组的10年心肌梗死发生率分别为10.3%、13.3%和20.7%(P<；0.010)。冠状动脉旁路移植术、经皮冠状动脉介入术和同种异体移植的10年再血管化率分别为7.4%、41.9%和39.4%(P<；0.001)。COX回归分析显示，相对于复合终点，MT组的原发事件发生率高于CABG组(危险比2.35，95%可信区间1.78~3.11)，而经皮冠状动脉介入治疗组的原发事件发生率高于CABG组(危险比1.85，95%可信区间1.39~2.47)。另外，冠状动脉旁路移植组、冠脉搭桥组和移植组的10年无心绞痛率分别为%、59%和43%(P<；0.001)。结论：与冠脉搭桥组相比，移植组有显著更高的继发性心肌梗死发生率、更高的血运重建率、更高的心源性死亡发生率，因此合并事件的风险增加2.29倍。与冠状动脉旁路移植术相比，经皮冠状动脉介入治疗与进一步血运重建的需求增加、心肌梗死发生率增加以及合并事件的风险增加1.46倍相关。此外，CABG在消除心绞痛症状方面优于MT。
Background-This study compared the 10-year follow-up of percutaneous coronary intervention (PCI), coronary artery surgery (CABG), and medical treatment (MT) in patients with multivessel coronary artery disease, stable angina, and preserved ventricular function.Methods and Results-The primary end points were overall mortality, Q-wave myocardial infarction, or refractory angina that required revascularization. All data were analyzed according to the intention-to-treat principle. At a single institution, 611 patients were randomly assigned to CABG (n = 203), PCI (n = 205), or MT (n = 203). The 10-year survival rates were 74.9% with CABG, 75.1% with PCI, and 69% with MT (P = 0.089). The 10-year rates of myocardial infarction were 10.3% with CABG, 13.3% with PCI, and 20.7% with MT (P < 0.010). The 10-year rates of additional revascularizations were 7.4% with CABG, 41.9% with PCI, and 39.4% with MT (P < 0.001). Relative to the composite end point, Cox regression analysis showed a higher incidence of primary events in MT than in CABG (hazard ratio 2.35, 95% confidence interval 1.78 to 3.11) and in PCI than in CABG (hazard ratio 1.85, 95% confidence interval 1.39 to 2.47). Furthermore, 10-year rates of freedom from angina were 64% with CABG, 59% with PCI, and 43% with MT (P < 0.001).Conclusions-Compared with CABG, MT was associated with a significantly higher incidence of subsequent myocardial infarction, a higher rate of additional revascularization, a higher incidence of cardiac death, and consequently a 2.29-fold increased risk of combined events. PCI was associated with an increased need for further revascularization, a higher incidence of myocardial infarction, and a 1.46-fold increased risk of combined events compared with CABG. Additionally, CABG was better than MT at eliminating anginal symptoms.