Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel coronary artery disease in the bare-metal stent era
Long-term outcomes of coronary-artery bypass graft surgery versus percutaneous coronary intervention for multivessel coronary artery disease in the bare-metal stent era
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DOI：
10.1161/circulationaha.107.735902
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发表时间：
2008-09-30
期刊：
影响因子：
37.8
通讯作者：
Kita, Toru
中科院分区：
文献类型：
--
作者：
Kimura, Takeshi;Morimoto, Takeshi;Kita, Toru
背景-观察注册比较冠状动脉旁路移植术（CABG）手术和经皮冠状动脉介入治疗（PCI）的长期生存结果，是不一致的随机trials.Methods和Results-We进行了一项多中心研究，在日本招募2000年1月和2002年12月之间的第一次CABG或PCI的连续患者。在入组的9877例患者中，5420例（PCI：3712例，CABG：1708例）患有多支血管疾病，无左主干受累。因为年龄是选择血运重建策略的重要决定因素，生存分析按年龄≥ 75岁或< 75岁分层。还在其他相关亚组中进行了分析。中位随访间隔为1284天，2年随访率为95%。3年时，CABG组和PCI组的未校正生存率分别为91.7%和89.6%（对数秩P = 0.26）。校正基线特征后，CABG后的生存结局倾向于更好（PCI与CABG后死亡的风险比[HR]，95%置信区间[CI]：1.23 [0.99-1.53]，P = 0.06）。在老年患者中，CABG的校正生存结局也倾向于更好（HR [95% CI]：1.37 [0.98-1.92] P = 0.07），但在非老年患者中并非如此（HR [95% CI]：1.09 [0.82-1.46]，P = 0.55）。未调整和调整后的生存结果CABG和PCI没有显着差异，在任何亚组时，老年患者被排除在analysis. Conclusions，在CREDO京都注册，生存结果之间的患者< 75岁的PCI和CABG后相似，结果是一致的随机试验。
Background-Observational registries comparing coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) have reported long-term survival results that are discordant with those of randomized trials.Methods and Results-We conducted a multicenter study in Japan enrolling consecutive patients undergoing first CABG or PCI between January 2000 and December 2002. Among 9877 patients enrolled, 5420 (PCI: 3712, CABG: 1708) had multivessel disease without left main involvement. Because age is an important determinant when choosing revascularization strategies, survival analysis was stratified by either age >= 75 or < 75 years. Analyses were also performed in other relevant subgroups. Median follow-up interval was 1284 days with 95% follow-up rate at 2 years. At 3 years, unadjusted survival rates were 91.7% and 89.6% in the CABG and PCI groups, respectively (log rank P = 0.26). After adjustment for baseline characteristics, survival outcome tended to be better after CABG (hazard ratio for death after PCI versus CABG [HR], 95% confidence interval [CI]: 1.23 [0.99-1.53], P = 0.06). Adjusted survival outcomes also tended to be better for CABG among elderly patients (HR [95% CI]: 1.37 [0.98-1.92] P = 0.07), but not among nonelderly patients (HR [95% CI]: 1.09 [0.82-1.46], P = 0.55). Unadjusted and adjusted survival outcome for CABG and PCI were not significantly different in any subgroups when elderly patients were excluded from analysis.Conclusions-In the CREDO-Kyoto registry, survival outcomes among patients < 75 years of age were similar after PCI and CABG, a result that is consistent with those of randomized trials.