A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. German Angioplasty Bypass Surgery Investigation (GABI)
A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease. German Angioplasty Bypass Surgery Investigation (GABI)
复制标题
一项对有症状的多支冠状动脉疾病患者进行冠状动脉血管成形术与搭桥手术比较的随机研究。
DOI：
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发表时间：
1994
影响因子：
158.5
通讯作者：
Walter Bleifeld
中科院分区：
文献类型：
--
作者：
C. W. Hamm;J. Reimers;T. Ischinger;H. Rupprecht;J. Berger;Walter Bleifeld
背景
有症状的多支冠状动脉疾病患者的标准治疗方法是冠状动脉旁路移植术（CABG）。经皮冠状动脉腔内成形术（PTCA）被广泛用作血运重建的替代方法，但需要对两种手术进行系统比较。我们比较了使用 CABG 或 PTCA 进行完全血运重建一年后患者的结果。
方法
8个临床中心共筛查了8981名多支冠状动脉疾病患者，其中359名患者被随机分配接受CABG（177名患者）或PTCA（182名患者）。入组要求对至少两条供应不同心肌区域的主要血管进行完全血运重建被认为在临床上是必要的并且在技术上是可行的。
结果
CABG组患者平均移植血管2.2±0.6条，PTCA组患者平均扩张血管1.9±0.5条。 CABG 后住院时间更长（中位 19 天，而 PTCA 为 5 天），与手术相关的 Q 波心肌梗死更频繁（8.1%，而 PTCA 后为 2.3%；P = 0.022），而两组之间的院内死亡率没有显着差异（CABG 组为 2.5%，PTCA 组为 1.1%）。出院时，CABG 组中 93% 的患者没有出现心绞痛，而 PTCA 组中这一比例为 82% (P = 0.005)。在随访的第一年中，PTCA 组中 44% 的患者需要进一步干预（23% 重复接受 PTCA，18% 接受 CABG，两者均为 3%），但 CABG 组中只有 6% 的患者需要进一步干预（1% 重复接受 CABG，5% 重复接受 PTCA；P < 0.001）。治疗一年后，CABG 组中 74% 的患者和 PTCA 组中 71% 的患者没有出现心绞痛。两组的运动能力都有相似的提高。然而，CABG 组中有 22% 的人不需要抗心绞痛药物，而 PTCA 组中只有 12% 的人不需要抗心绞痛药物 (P = 0.041)。
结论
在选定的患有多支冠状动脉疾病的患者中，PTCA 和 CABG 作为初始治疗一年后心绞痛得到了同等的改善。然而，为了达到相似的临床结果，接受 PTCA 治疗的患者更有可能需要进一步的干预和抗心绞痛药物，而接受 CABG 治疗的患者更有可能在手术时维持急性心肌梗死。
BACKGROUND
The standard treatment for patients with symptomatic multivessel coronary artery disease is coronary-artery bypass grafting (CABG). Percutaneous transluminal coronary angioplasty (PTCA) is widely used as an alternative approach to revascularization, but a systematic comparison of the two procedures is needed. We compared the outcomes in patients one year after complete revascularization with CABG or PTCA.
METHODS
A total of 8981 patients with multivessel coronary disease were screened at eight clinical sites, and 359 patients were randomly assigned to undergo CABG (177 patients) or PTCA (182 patients). Enrollment required that complete revascularization of at least two major vessels supplying different myocardial regions be deemed clinically necessary and technically feasible.
RESULTS
Among the patients in the CABG group, an average of 2.2 +/- 0.6 vessels were grafted, and among those in the PTCA group, 1.9 +/- 0.5 vessels were dilated. After CABG, hospitalization was longer (median, 19, as compared with 5 days for PTCA), and Q-wave myocardial infarction in relation to the procedure was more frequent (8.1 percent, as compared with 2.3 percent after PTCA; P = 0.022), whereas in-hospital mortality did not differ significantly between the two groups (2.5 percent in the CABG group and 1.1 percent in the PTCA group). At discharge 93 percent of the patients in the CABG group were free of angina, as compared with 82 percent of those in the PTCA group (P = 0.005). During the first year of follow-up, further interventions were necessary in 44 percent of the patients in the PTCA group (repeated PTCA in 23 percent, CABG in 18 percent, and both in 3 percent) but in only 6 percent of the patients in the CABG group (repeated CABG in 1 percent and PTCA in 5 percent; P < 0.001). Seventy-four percent of the patients in the CABG group and 71 percent of those in the PTCA group were free of angina one year after treatment. Exercise capacity improved similarly in both groups. However, 22 percent of the CABG group, as compared with only 12 percent of the PTCA group, did not require antianginal medication (P = 0.041).
CONCLUSIONS
In selected patients with multivessel coronary disease, PTCA and CABG as initial treatments resulted in equivalent improvement in angina after one year. However, in order to achieve similar clinical outcomes, the patients treated with PTCA were more likely to require further interventions and antianginal drugs, whereas the patients treated with CABG were more likely to sustain an acute myocardial infarction at the time of the procedure.
1985-1986年和1977-1981年进行经皮腔内冠状动脉成形术。
DOI：
10.1056/nejm198802043180501
发表时间：
1988
期刊：
The New England journal of medicine
影响因子：
--
作者：
Detre,K;Holubkov,R;Kelsey,S;Cowley,M;Kent,K;Williams,D;Myler,R;Faxon,D;HolmesJr,D;Bourassa,M
通讯作者：
Bourassa,M