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目的:探讨药物洗脱支架(DES)治疗冠心病多支冠状动脉(冠脉)病变患者的临床疗效,并与冠脉旁路移植术进行比较。方法:入选2005-01-2008-01在我院行血管重建术的215例冠心病多支冠脉病变患者,其中114例行DES置入术(DES组),101例行冠脉旁路移植术(CABG组)。比较2组住院期和随访期不良心血管事件(死亡、非致死性心肌梗死、再次血管重建术和脑血管意外)的发生情况。结果:2组的临床和冠脉病变特征相似,与DES组比较,CABG组左主干病变(29.2%∶5.0%,P<0.01)、LVEF<50%发生率(39.7%∶19.2%,P<0.01)和完全血管重建率(81.2%∶58.8%,P<0.01)较高。住院期2组总体不良心血管事件发生率无明显差异,但CABG组住院期病死率有增高趋势(6.9%∶1.8%,P>0.05)。平均临床随访12～36(17±9)个月,2组总体不良心血管事件发生率仍无明显差异(9.6%∶13.4%,P>0.05),但DES组再次血管重建的发生率较CABG组有增高趋势(9.8%∶2.1%,P>0.05)。结论:DES置入术应用在冠心病多支冠脉病变患者中安全可行,总体不良心血管事件发生率与CABG无明显差异。
Objective: To investigate the clinical efficacy of drug-eluting stent (DES) in the treatment of coronary artery disease with multiple coronary artery disease (coronary artery disease) and compare with coronary artery bypass grafting. Methods: A total of 215 patients with coronary artery disease with coronary artery disease undergoing revascularization in our hospital from January 2005 to January 2008 were enrolled. 114 patients underwent DES implantation (DES group) and 101 patients underwent coronary artery bypass grafting Surgery (CABG group). The incidence of adverse cardiovascular events (death, non-fatal myocardial infarction, revascularization and cerebrovascular accident) during the hospitalization and follow-up periods were compared between the two groups. Results: Compared with the DES group, the left main coronary artery lesion in CABG group (29.2% vs5.0%, P <0.01), the incidence of LVEF <50% (39.7%: 19.2%, P < 0.01) and complete revascularization rate (81.2%: 58.8%, P <0.01). There was no significant difference in overall incidence of adverse cardiovascular events between the two groups during hospitalization, but there was an increasing trend of in-hospital mortality in CABG group (6.9% vs 1.8%, P> 0.05). The average clinical follow-up ranged from 12 months to 36 months (17 ± 9 months). There was no significant difference in adverse cardiovascular events between the two groups (9.6% vs 13.4%, P> 0.05). However, the incidence of revascularization in DES group was significantly higher than that in CABG Group increased trend (9.8%: 2.1%, P> 0.05). Conclusion: DES implantation is safe and feasible in patients with coronary artery disease with multiple branches of coronary artery disease. There is no significant difference between the incidence of adverse cardiovascular events and CABG.