Myocardial infarction and cardiac mortality in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial.
Myocardial infarction and cardiac mortality in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial.
复制标题
搭桥血管成形术血运重建研究 (BARI) 随机试验中的心肌梗死和心脏死亡率。
DOI：
10.1161/01.cir.96.7.2162
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发表时间：
1997
期刊：
影响因子：
37.8
通讯作者：
Frye,R
中科院分区：
文献类型：
--
作者：
Chaitman,BR;Rosen,AD;Williams,DO;Bourassa,MG;Aguirre,FV;Pitt,B;Rautaharju,PM;Rogers,WJ;Sharaf,B;Attubato,M;Hardison,RM;Srivatsa,S;Kouchoukos,NT;Stocke,K;Sopko,G;Detre,K;Frye,R
研究背景心脏病死亡率和心肌梗死（MI）率是评价冠状动脉旁路移植术（CABG）和经皮冠状动脉腔内成形术（PTCA）疗效的指标。我们比较了1829例多支血管疾病患者随机接受CABG或PTCA.Methods和ResultsThe 5年心源性死亡率和MI率，在分配到PTCA的患者中，5年心源性死亡率为8.0%，而在分配到CABG的患者中，5年心源性死亡率为4.9%（相对危险度[RR]为1.55，95%置信区间[CI]为1.07至2.23;P=.022）。在1476例非糖尿病患者的亚组中，两个治疗组的心源性死亡率在总体上（4.6% vs 4.2%; RR=1.04，95%CI，0.65 - 1.66;P= 0.908）或基于症状、左心室功能、病变血管数量或近端左前降支狭窄的亚组中均无显著差异。两个治疗组的心源性死亡或MI联合终点事件发生率相似。264例心肌梗死患者与非心肌梗死患者相比，心源性死亡的RR为5.9（P<0.001）。MI在CABG术后住院期间更常见（P=.004），但在PTCA组中，MI在出院后更常见（P<.001.ConclusionsThe Bypass Angioplasty Revascularization Investigation（巴里）trial表明，多支血管疾病患者在初次治疗后，经皮冠状动脉成形术（PTCA）的5年心脏死亡率明显高于CABG。在药物治疗的糖尿病患者中，这种差异是明显的。两治疗组之间的心源性死亡或MI复合终点或非糖尿病患者的心源性死亡总体上无显著差异，无论症状、左心室功能、病变血管数量或左前降支近端狭窄。
BackgroundCardiac mortality and myocardial infarction (MI) rates are used to evaluate the efficacy of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). We compared 5-year cardiac mortality and MI rates in 1829 patients with multivessel disease randomized to CABG or PTCA.Methods and ResultsThe 5-year cardiac mortality rate was 8.0% in patients assigned to PTCA compared with 4.9% in those assigned to CABG (relative risk [RR] of 1.55 with a 95% confidence interval [CI] of 1.07 to 2.23;P=.022). In a subgroup of 1476 nondiabetic patients, there were no significant differences between treatment groups in cardiac mortality either overall (4.6% versus 4.2%; RR=1.04, 95% CI, 0.65 to 1.66;P=.908) or in subgroups based on symptoms, left ventricular function, number of diseased vessels, or stenotic proximal left anterior descending artery. The two treatment groups had similar event rates for the combined end point of cardiac death or MI. The RR for cardiac mortality in 264 patients who sustained an MI compared with those who did not was 5.9 (P<.001). MIs were more common after CABG during index hospitalization (P=.004), but in the PTCA group, they were more common after discharge (P<.001).ConclusionsThe Bypass Angioplasty Revascularization Investigation (BARI) trial indicates 5-year cardiac mortality in patients with multivessel disease was significantly greater after initial treatment with PTCA than with CABG. The difference was manifest in diabetic patients on drug therapy. There were no significant differences overall for the composite end point of cardiac mortality or MI between treatment groups or for cardiac mortality in nondiabetic patients regardless of symptoms, left ventricular function, number of diseased vessels, or stenotic proximal left anterior descending artery.