Circulation:药物洗脱支架对比冠脉搭桥治疗冠脉疾病的10年随访结果

2020-05-09 QQY MedSci原创

药物洗脱支架经皮冠状动脉介入治疗(PCI)和左主冠状动脉疾病的冠状动脉搭桥术(CABG)的长期相对预后一直存在争议。

药物洗脱支架经皮冠状动脉介入治疗(PCI)和左主冠状动脉疾病的冠状动脉搭桥术(CABG)的长期相对预后一直存在争议。

在PRECOMBAT试验中,2004年4月-2009年8月,在韩国的13家医院中,无保护的左主冠状动脉疾病患者被随机分配接受PCI西罗莫司洗脱支架(300例)或CABG(300例)治疗。所有患者至少随访10年(中位随访11.3年)。主要终点是心血管或脑血管不良事件的发生率(包括全因死亡、心肌梗死、卒中或缺血驱动的靶血管重建)。

10年时,PCI组和CABG组的主要终点发生率分别为29.8%和24.7%(PCI vs CABG的风险比[HR]:1.25[95% CI 0.93-1.69])。PCI组合CABG组死亡、心肌梗死或卒中的10年复合发生率为18.2% vs 17.5%(HR 1.0[95% CI 0.70-1.44]),全因死亡率的10年发生率为14.5% vs 13.8%(1.13[0.75-1.70]),均无显著性差异。PCI组缺血驱动的靶血管重建率高于CABG组(16.1% vs 8.0%;HR 1.98[CI 1.21-3.21])。

综上所述,PRECOMBAT试验的10年随访结果显示左主冠状动脉疾病患者采用PCI或CABG治疗的长期心脑血管不良事件的发生率无明显差异。应进一步开展实验验证该结果。

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    2020-05-11 yese
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