Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease
Ki Bae SeungDuk‐Woo ParkYoung‐Hak KimSeung‐Whan LeeCheol Whan LeeMyeong‐Ki HongSeong‐Wook ParkSung‐Cheol YunHyeon‐Cheol GwonMyung‐Ho JeongYangsoo JangHyo‐Soo KimPum Joon KimIn Whan SeongHun Sik ParkTaehoon AhnIn‐Ho ChaeSeung‐Jea TahkWook-Sung ChungSeung‐Jung Park
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Abstract:
Several studies have compared the treatment effects of coronary stenting and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term outcomes of these two interventions for patients with unprotected left main coronary artery disease.We evaluated 1102 patients with unprotected left main coronary artery disease who underwent stent implantation and 1138 patients who underwent CABG in Korea between January 2000 and June 2006. We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) with the use of propensity-score matching in the overall cohort and in separate subgroups according to type of stent.In the overall matched cohort, there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio for the stenting group, 1.18; 95% confidence interval [CI], 0.77 to 1.80) or the risk of the composite outcome (hazard ratio for the stenting group, 1.10; 95% CI, 0.75 to 1.62). The rates of target-vessel revascularization were significantly higher in the group that received stents than in the group that underwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisons of the group that received bare-metal stents with the group that underwent CABG and of the group that received drug-eluting stents with the group that underwent CABG produced similar results, although there was a trend toward higher rates of death and the composite end point in the group that received drug-eluting stents.In a cohort of patients with unprotected left main coronary artery disease, we found no significant difference in rates of death or of the composite end point of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization than was CABG.Keywords:
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近年来,药物洗脱支架(drug-eluting stent,DES)的应用使经皮冠状动脉介入治疗(percutaneouscoronary intervention,PCI)术后再狭窄率显著降低.但影响患者介入术后近期和远期预后的因素不仅仅是冠状动脉本身的病变特点、采取的技术策略和支架类型,伴随的临床情况和动脉硬化相关危险因素也与支架术后再狭窄和动脉硬化的进展有着不可忽视的关系.因此,在DES广泛应用的今天,冠心病介入医师在制定治疗决策和评估预后时不应只关注病变,还应更多地关注患者。
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Objective:To evaluate the influence of complete or incomplete revascularization on the life quality of elderly patients with multivessel coronary artery disease. Methods:The study retrospectively analyzed the clinical data and the quality of life assessment result in the elderly patients with multivessel coronary artery disease,who were over 60 years,underwent percutaneous coronary intervention(PCI) procedure from June 2003 to December 2004 in our center,and followed-up for 2 years with the 36 items short form health survey(SF-36).Results:All domains,except that for mental health,assessed by the SF-36 showed significantly higher scores after revascularization by PCI,and the scores in completely revascularized patients were higher than those in incompletely revascularized patients. Conclusion:PCI can significantly improve the quality of life and the improvement is better with complete than with incomplete revascularization.
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