Analyses of the long-term outcomes and prognostic factors of Japanese patients undergoing first coronary revascularization.

进行了一项多中心研究，纳入了2000年1月至2002年12月期间接受首次PCI或CABG的冠状动脉疾病连续患者。一周内发生急性心肌梗死的患者已被排除在入组的9，877例患者中，5，420例（PCI：3，712例，CABG：1，708例）患有多支血管疾病，无左主干受累。本研究比较了5,420例可能有CABG指征的患者PCI与CABG的预后。由于年龄是决定血运重建策略的一个非常重要的决定因素，因此还对年龄≥ 75岁或<75岁的分层亚组进行了生存分析。还在其他相关亚组中进行了分析。3年时，PCI组（89.6%）和CABG组（91.7%）的未校正生存率相当（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）。在年龄> 75岁的患者中，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），但在年龄<75岁的患者中并非如此（BR（95%CI）：1.09（0.82-1.46），p= 0.55）。当从分析中排除老年患者（75岁）时，CABG和PCI的未校正和校正生存结局在任何亚组中均无显著差异。关于免于任何血运重建手术的比率，PCI组和CABG组之间存在显著差异。在3年时，PCI组中只有51.7%的患者未接受任何血运重建手术，而CABG组中有90.2%的患者未接受任何血运重建手术，因此，PCI和CABG后<75岁患者的生存结局相似，而PCI后的患者在裸金属支架时代经常接受冠状动脉血运重建手术。

A multicenter study enrolling consecutive patients with coronary artery disease undergoing first PCI or CABG between January 2000 and December 2002 has been conducted. Patients with acute myocardial infarction within a week have been excluded from enrollment Among the 9,877 patients enrolled, 5,420 (PCI: 3,712, CABG: 1,708) had multivessel disease without left main involvement. The present study compared the prognosis of PCI versus CABG in the 5,420 patient s who have possible indication of CABG. Because age is a very important determinant when deciding revascularization strategies, survival analysis was also performed in the stratified subgroups by either age 〓 75 or <75 years. Analyses were also performed in other relevant subgroups. At 3 years, unadjusted survival rates were comparable between the PCI (89.6%) and CABG (91.7%) groups (log rank p=0.26). After adjustment for baseline characteristics, survival outcome tended to be better after CABG (hazard ratio for death after PCI vs. 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 the patients 〓 75 years (HR (95%CI): 1.37 (0.98-1.92), p= 0.07), but not among the patients <75 years (BR (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 ($75 years) were excluded from analysis. In regard to the rate of freedom from any revascularization procedures, there was a striking difference between the PCI and CABG groups. At 3 years, only 51.7% of patients in the PCI group were free from any revascularization procedures as compared with 90.2% of patients in the CABG group.Thus, survival outcomes among patients <75 years of age were similar after PCI and CABG, while the patients after PCI often underwent coronary revascularization procedures in the era of bare metal stent.