Comparative effectiveness of revascularization strategies.
Comparative effectiveness of revascularization strategies.
复制标题
DOI：
10.1056/nejmoa1110717
复制
发表时间：
2012-04-19
期刊：
影响因子：
--
通讯作者：
Edwards FH
中科院分区：
文献类型：
--
作者：
Weintraub WS;Grau-Sepulveda MV;Weiss JM;O'Brien SM;Peterson ED;Kolm P;Zhang Z;Klein LW;Shaw RE;McKay C;Ritzenthaler LL;Popma JJ;Messenger JC;Shahian DM;Grover FL;Mayer JE;Shewan CM;Garratt KN;Moussa ID;Dangas GD;Edwards FH
关于经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）的比较有效性的问题仍然存在。美国心脏病学会基金会（ACCF）和胸外科医师协会（STS）合作比较了PCI和CABG后的长期生存率。我们将ACCF国家心血管数据登记处和STS成人心脏手术数据库与医疗保险和医疗补助服务中心2004年至2008年的索赔数据联系起来。结果与使用倾向评分和逆概率加权调整进行比较，以减少治疗选择偏倚。在65岁或65岁以上患有两支或三支冠状动脉疾病而无急性心肌梗死的患者中，86，244例接受了CABG，103，549例接受了PCI。中位随访时间为2.67年。1年时，两组之间的校正死亡率无显著差异（CABG组为6.24%，PCI组为6.55%;风险比为0.95; 95%置信区间[CI]为0.90 - 1.00）。4年时，CABG的死亡率低于PCI（16.4% vs. 20.8%;风险比，0.79; 95% CI，0.76 - 0.82）。在多个亚组和使用几种不同的分析方法中观察到相似的结果。通过敏感性分析评估剩余混杂因素。在这项观察性研究中，我们发现，在不需要急诊治疗的多支冠状动脉疾病老年患者中，与接受PCI的患者相比，接受CABG的患者的长期生存率更高。（由国家心脏，肺和血液研究所资助。
Questions persist concerning the comparative effectiveness of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG). The American College of Cardiology Foundation (ACCF) and the Society of Thoracic Surgeons (STS) collaborated to compare the rates of long-term survival after PCI and CABG. We linked the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to claims data from the Centers for Medicare and Medicaid Services for the years 2004 through 2008. Outcomes were compared with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment-selection bias. Among patients 65 years of age or older who had two-vessel or three-vessel coronary artery disease without acute myocardial infarction, 86,244 underwent CABG and 103,549 underwent PCI. The median follow-up period was 2.67 years. At 1 year, there was no significant difference in adjusted mortality between the groups (6.24% in the CABG group as compared with 6.55% in the PCI group; risk ratio, 0.95; 95% confidence interval [CI], 0.90 to 1.00). At 4 years, there was lower mortality with CABG than with PCI (16.4% vs. 20.8%; risk ratio, 0.79; 95% CI, 0.76 to 0.82). Similar results were noted in multiple subgroups and with the use of several different analytic methods. Residual confounding was assessed by means of a sensitivity analysis. In this observational study, we found that, among older patients with multivessel coronary disease that did not require emergency treatment, there was a long-term survival advantage among patients who underwent CABG as compared with patients who underwent PCI. (Funded by the National Heart, Lung, and Blood Institute.)