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老年无保护左主干病变置入药物洗脱支架与行冠状动脉旁路移植术的预后比较 被引量:3

Comparison between drug eluting stent and coronary artery bypass grafting surgery for the treatment of unprotected left main coronary artery disease in elderly patients
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摘要 目的对比老年无保护左主干病变患者置入药物洗脱支架(DES)和行冠状动脉旁路移植术(CABG)后2年的临床预后。方法入选2004年1月至2006年6月因无保护左主干病变置入DES或行CABG的老年患者(1〉70岁)共295例。随访2年,记录患者发生全因死亡、非致死性心肌梗死及靶病变血管重建的情况。结果共206例患者行CABG,89例患者置入DES。随访2年的累积死亡率CABG组为10.2%,DES组为13.3%,两组之间差异无统计学意义(P=0.428)。生存分析表明2年生存率CABG组为89.2%,DES组为86.4%,两组之间差异无统计学意义(P=0.668)。2年心肌梗死发生率CABG组为10.1%,DES组为7.8%,两组之间差异无统计学意义(P=0.501)。DES组2年内靶病变血管重建的发生率明显高于CABG组(13.5%比4.9%,P=0.015)。多因素分析表明,年龄(HR:1.04,95% CI:1.01~1.09,P=0.024)、左心室功能不全(LVEF〈30%)(HR:4.97,95% CI:1.22~24.85,P=0.018)以及2型糖尿病(HR:2.22,95% CI:1.31~4.86,P=0.001)均是死亡的独立危险因素。结论对于≥70岁的老无保护左主干病变患者,行CABG和置入DES后2年的生存率相当,但置入DES的患者靶病变血管重建发生率明显高于行CABG的患者。 Objective To compare the 2 years outcome of elderly patients with ULMCA stenosis undergoing coronary artery bypass grafting (CABG) or drug eluting stent(DES). Methods From January 2004 to June 2006, 295 patients with ULMCA stenosis and age ≥ 70 years undergoing coronary revascularization with either CABG (n = 206) or DES ( n = 89) were enrolled in this analysis. All-cause death, non-fatal myocardial infarction and target lesion revascularization (TLR) were recorded during 2 years follow-up. Results The cumulative rate of 2-year mortality were 10. 2% ( n = 21 ) in CABG-treated patients and 13.3% ( n = 12 ) in DES -treated patients ( P = 0. 428 ). The survival rate during 2-year follow-up was 89. 2% for CABG-treated patients and 86. 4% for DES-treated patients ( P = 0. 668 ). The incidence of 2-year myocardial infarction was 7.8% (n = 16) in CABG-treated patients and 10. 1% (n =9) in DES-treated patients ( P = 0. 501 ). The incidence of target lesion revascularization (TLR) was 4. 9% (n = 10) in CABG-treated patients and 13.5% ( n = 12) in DES-treated patients ( P = 0. 015 ). In the multivariable analysis, age ( HR: 1.04,95% CI: 1.01-1.09, P = 0. 024 ) , left ventricular dysfunction ( ejection fraction 〈 30%, HR : 4.97,95 % CI: 1.22-24. 85, P = 0. 018 ) and type 2 diabetes ( HR : 2. 22, 95% CI: 1.31-4. 86, P = 0. 001 ) were independent predictors of 2-year mortality. Conclusion In this study, 2-yaer mortality was comparable in elderly patients with ULMCA stenosis underwent CABG or DES. However, the rate of TLR was significantly higher in patients treated with DES than that receiving CABG operation.
出处 《中华心血管病杂志》 CAS CSCD 北大核心 2009年第9期769-772,共4页 Chinese Journal of Cardiology
关键词 冠状动脉疾病 老年人 支架 冠状动脉分流术 Coronary disease Aged Stents Coronary artery bypass
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参考文献16

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同被引文献49

  • 1张广成,孙冰,汪捷猛.药物洗脱支架植入与冠状动脉旁路移植术治疗多支冠状动脉病变临床疗效的对比研究[J].中外医疗,2007(21):1-2. 被引量:2
  • 2薛松.冠状动脉外科进展[J].外科研究与新技术,2014,3(2):92-95. 被引量:3
  • 3徐勤成,孙晓斐,丛培玲,张申,任长杰,郝丽.复杂冠脉病变经皮冠状动脉介入治疗与冠状动脉旁路移植术的临床比较[J].济宁医学院学报,2005,28(2):17-19. 被引量:2
  • 4牛煜瑾,王禹,陈练,杨庭树,盖鲁粤,孙志军,金琴花,张国明.无保护左主干病变患者经皮介入治疗的即刻及远期疗效分析[J].中华老年心脑血管病杂志,2007,9(4):226-228. 被引量:3
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  • 7Serruys PW, Morice MC, Kappetein AP, et al SYNTAX Investi- gators. Percutaneous coronary intervention versus coronary-ar- tery bypass grafting for severe coronary artery disease[J]. N Eng! J Med,2009,360(10) z961-972.
  • 8Seung KB,Park DW,Kim YH,et al. Stents versus coronary-ar- tery bypass grafting for left main coronary artery disease[J]. N Engl J Med,2008,358(17) :1781-1792.
  • 9Valgimigli M,Malagutti P,Rodriguez Granillo GA,etal. Single- vessel versus bifurcation stenting for the treatment of distal left main coronary artery disease in the drug-eluting stenting era. Clinical and angiographie insights into the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RE- SEARCH) and Taxus-Stertt Evaluated at Rotterdam Cardiology Hospital (T-SEARCH) registries[J]. Am Heart J, 2006, 152 (5) .896-902.
  • 10张天嵩,钟文昭.实用循证医学方法学[M].长沙:中南大学出版社,2012:352—379.

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