Coronary artery bypass surgery versus coronary stenting: risk-adjusted survival rates in 5,619 patients.
Coronary artery bypass surgery versus coronary stenting: risk-adjusted survival rates in 5,619 patients.
复制标题
冠状动脉搭桥手术与冠状动脉支架置入术：5,619 名患者的风险调整生存率。
DOI：
--
复制
发表时间：
2002
影响因子：
0.9
通讯作者：
James M Wilson
中科院分区：
文献类型：
--
作者：
R. Villareal;V. Lee;M. Elayda;James M Wilson
我们使用德克萨斯心脏研究所心血管研究数据库，回顾性识别1995年1月至1999年12月期间接受首次血运重建术（冠状动脉旁路手术（CABG; n= 2，826）或冠状动脉支架植入术（n= 2，793））的患者。根据冠状动脉病变血管的数量和有无近端左前降支病变将患者分为8个解剖组。采用比例风险法校正死亡率，以校正疾病严重程度和合并症的基线差异。我们发现接受冠状动脉旁路移植术的患者的住院死亡率明显高于接受支架植入术的患者（3.6% vs 0.75%;调整后OR 8.4; P < 0.0001）。在平均2.5年的随访中，风险调整生存率相当（CABG 91%，支架植入95%;调整OR 1.26; P = 0.06）。当对疾病严重程度匹配的亚组进行比较时，没有发现风险调整生存率的差异。在3类患者中观察到支架植入术的生存优势：年龄>65岁（OR 1.33，P = 0.049）、非胰岛素依赖型糖尿病（OR 2.06，P = 0.002）和任何非冠状动脉血管疾病（OR 1.59，P = 0.009）。在这项非随机观察性研究中，CABG的围手术期死亡率高于经皮支架植入术。然而，在2.5年时，支架植入术的生存优势不再明显。这些数据表明，对于多支血管病变的患者，冠状动脉旁路移植术与支架植入术相比，在中期生存率方面没有优势。
We used the Texas Heart Institute Cardiovascular Research Database to retrospectively identify patients who had undergone their 1st revascularization procedure with coronary artery bypass surgery (CABG; n=2,826) or coronary stenting (n=2,793) between January 1995 and December 1999. Patients were classified into 8 anatomic groups according to the number of diseased vessels and presence or absence of proximal left anterior descending coronary artery disease. Mortality rates were adjusted with proportional hazards methods to correct for baseline differences in severity of disease and comorbidity. We found that in-hospital mortality was significantly greater in patients undergoing CABG than in those undergoing stenting (3.6% vs 0.75%; adjusted OR 8.4; P < 0.0001). At a mean 2.5-year follow-up, risk-adjusted survival was equivalent (CABG 91%, stenting 95%; adjusted OR 1.26; P = 0.06). When subgroups matched for severity of disease were compared, no differences in risk-adjusted survival were seen. A survival advantage of stenting was noted in 3 categories of patients: those >65 years of age (OR 1.33, P = 0.049), those with non-insulin-requiring diabetes (OR 2.06, P = 0.002), and those with any noncoronary vascular disease (OR 1.59, P = 0.009). In this nonrandomized observational study, CABG had a higher periprocedural mortality rate than did percutaneous stenting. At 2.5 years, however, the survival advantage of stenting was no longer evident. These data suggest that there is no intermediate-term survival advantage of CABG over stenting in patients who have multivessel disease with lesions that can be treated percutaneously.
影响因子：
37.8
作者：
Detre,KM;HolmesJr,DR;Holubkov,R;Cowley,MJ;Bourassa,MG;Faxon,DP;Dorros,GR;Bentivoglio,LG;Kent,KM;Myler,RK
通讯作者：
Myler,RK