高龄冠心病患者经皮冠状动脉介入治疗与冠状动脉旁路移植术的比较

摘要

Objective To compare the clinical results of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in elderly patient (>75 years) with coronary artery disease. Methods Two hundred and twelve elderl patients were divided respectively into PCI group and CABG group. Clinical, angiographic and revascularization data were collected. The primary endpoint was Major Adverse Cardiovascular and Cerebral Events (MACCE, including death, new-onset myocardial infarction, stroke and repeat revascularization) in-hospital and during follow-ups. Results Compared with CABG group, PCI group had Lower in-hospital MACCE rates (0.9% vs 5.3% ,X2 =18.4, P<0.01) and in-hospital mortality (2.0% vs 7.9%, X2 =4.3, P <0.05). Multivariate Logistic regression analysis indicated that in-hospital MACCE risk in CABG group was higher than PCI group (OR =5.73,95% CI 1.00-32.86, P < 0.05). Follow-up MACCE rates of both groups were not significant (17.2% vs 13.7% ,P =20. 57). Multivariate Cox regression analysis indicated that CABG group had higher follow-up MACCE risk than that of PCI group. Conclusions Compared with CABG,PCI has lower in-hospital and follow-up MACCE rates in elderly patients with coronary artery disease.%目的 比较高龄患者经皮冠状动脉介入治疗(PCI)支架术与冠状动脉旁路移植术(CABG)对住院与临床随访结果的影响.方法 212例高龄(年龄>75岁)患者,根据血运重建方式的不同将其分为PCI支架组149例和CABG组63例,记录其临床与造影特征、血运重建情况和住院临床结果等资料,并进行临床随访.主要观察终点为住院与随访主要不良心脑血管事件(MACCE).所有资料采用SPSS 13.0软件进行统计分析,以P<0.05为差异有统计学意义.结果 与CABG组相比,PCI组的院内MACCE发生率较低(2.0%vs 12.7%,x2=10.3,P<0.05);院内死亡率较低(2.0%V8 7.9%,X2=4.3,P<0.05).多因素Logistic回归分析显示,CABG组院内MACCE发生的风险显著高于PCI组(P<0.05).平均随访19个月(中位时间579 d)显示,2组MACCE(17.2%V8 13.7%,P=0.57)、再次血运重建(P>0.05)、卒中发生率均无统计学意义(P>0.05).多因素Cox回归分析表明,与CABG组相比,PCI组随访期间MACCE风险较低(P<0.05).结论 与CABG相比,高龄冠心病患者PCI术后的院内及随访主要不良心脑血管事件发生率较低.