A comparison of the recovery of health status after percutaneous coronary intervention and coronary artery bypass
A comparison of the recovery of health status after percutaneous coronary intervention and coronary artery bypass
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DOI：
10.1016/s0003-4975(02)04063-8
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发表时间：
2002-11-01
影响因子：
4.6
通讯作者：
Spertus, JA
中科院分区：
文献类型：
--
作者：
Borkon, AM;Muehlebach, GF;Spertus, JA
背景冠状动脉血运重建术最佳模式的选择不仅应根据技术结果，还应考虑患者术后的健康状况，包括症状、功能和生活质量。采用西雅图心绞痛问卷（SAQ）对经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）后的健康状况进行分析和比较。对475例患者（252例PCI和223例CABG）在术前进行了SAQ，然后每月进行一次，持续6个月，并在1年时再次进行。通过多变量风险调整控制基线特征的差异，并使用重复测量方差分析比较随时间推移的结果。在住院期间，6个月和12个月的临床结局没有差异;然而，25%的PCI患者在研究期间需要至少一次再介入，而CABG患者仅为1%（p < 0.001）。尽管CABG患者在1个月时身体功能下降（p < 0.001），但在12个月时改善并优于PCI组（p = 0.008）。随着时间的推移，冠状动脉旁路移植术对心绞痛的缓解程度大于经皮冠状动脉介入治疗（p < 0.001），这主要是由于经皮冠状动脉介入治疗组中再狭窄的不良反应。多因素分析证实，与PCI相比，CABG独立地提供了更大的心绞痛缓解（P < 0.001）。术后12个月，CABG组的生活质量改善程度大于PCI组（P = 0.004）。在12个月的随访中，CABG患者的健康状况改善程度大于PCI患者，主要是由于PCI后再狭窄的不良影响。(C)2002年由胸外科医师协会出版。
Background. Selection of the optimum mode of coronary revascularization should not only be directed by technical outcomes, but should also consider patients' postprocedural health status, including symptoms, functionality, and quality of life.Methods. Health status was analyzed and compared after percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) using the Seattle Angina Questionnaire (SAQ). The SAQ was administered to 475 patients (252 PCI and 223 CABG) preprocedure and then monthly for 6 months and again at 1 year. Differences in baseline characteristics were controlled by multivariable risk adjustment, and outcomes over time were compared using repeated-measures analysis of variance.Results. In-hospital, 6-and 12-month clinical outcomes were not different; however, 25% of PCI patients required at least one reintervention during the study period, compared with only 1% of CABG patients (p < 0.001). Although physical function decreased for CABG patients at 1 month (p < 0.001), it improved and was better than the PCI group by 12 months (p = 0.008). Relief of angina was greater for CABG than PCI when analyzed over time (p < 0.001), principally due to the adverse effects of restenosis in the PCI group. Multivariable analysis confirmed that CABG independently conferred greater angina relief compared with PCI (P < 0.001). At 12 months postprocedure, quality of life had improved to a greater extent for CABG than PCI (P = 0.004).Conclusions. Over 12 months of follow-up, health status was improved to a greater extent for CABG patients than for PCI patients, primarily due to the adverse influence of restenosis after PCI. (C) 2002 by The Society of Thoracic Surgeons.