【学术】多支血管病变患者中依维莫司洗脱支架与CABG的转归比较2015-03-24长城国际心脏病学会议长城国际心脏病学会议长城国际心脏病学会议微信号gwiccorg功能介绍时刻了解长城国际心脏病学会议最新消息和学术资讯 （英文原文）Everolimus-Eluting Stents or Bypass Surgery for Multivessel CoronaryDiseaseBACKGROUNDResults of trialsand registry studies have shown lower long-term mortality after coronary-arterybypass grafting (CABG) than after percutaneous coronary intervention (PCI)among patients with multivessel disease. These previous analyses did notevaluate PCI with second-generation drug-eluting stents.METHODSIn an observationalregistry study， we compared the outcomes in patients with multivessel disease whounderwent CABG with the outcomes in those who underwent PCI with the use ofeverolimus-eluting stents. The primary outcome was all-cause mortality.Secondary outcomes were the rates of myocardial infarction， stroke， and repeatrevascularization. Propensity-score matching was used to assemble a cohort ofpatients with similar baseline characteristics.RESULTSAmong 34，819eligible patients， 9223 patients who underwent PCI with everolimus-elutingstents and 9223 who underwent CABG had similar propensity scores and wereincluded in the analyses. At a mean follow-up of 2.9 years， PCI witheverolimus-eluting stents， as compared with CABG， was associated with a similarrisk of death (3.1% per year and 2.9% per year， respectively; hazard ratio，1.04; 95% confidence interval [CI]， 0.93 to 1.17; P=0.50)， higher risks ofmyocardial infarction (1.9% per year vs. 1.1% per year; hazard ratio， 1.51; 95%CI， 1.29 to 1.77; P0.001) and repeat revascularization (7.2% per year vs.3.1% per year; hazard ratio， 2.35; 95% CI， 2.14 to 2.58; P0.001)， and alower risk of stroke (0.7% per year vs. 1.0% per year; hazard ratio， 0.62; 95%CI， 0.50 to 0.76; P0.001). The higher risk of myocardial infarction withPCI than with CABG was not significant among patients with complete revascularizationbut was significant among those with incomplete revascularization (P=0.02 forinteraction). CONCLUSIONSIn a contemporaryclinical-practice registry study， the risk of death associated with PCI witheverolimus-eluting stents was similar to that associated with CABG. PCI wasassociated with a higher risk of myocardial infarction (among patients withincomplete revascularization) and repeat revascularization but a lower risk ofstroke. (Funded by Abbott Vascular.)来源：CardioSource Journal scans（March 16，2015）多支血管病变患者中依维莫司洗脱支架与CABG的转归比较（中文摘要）近日美国《新英格兰医学杂志》发表一项研究显示，采用依维莫司洗脱支架行经皮冠脉介入术（PCI）与冠脉搭桥术（CABG）所致死亡危险相似。PCI与心肌梗死（在血运重建不完善的患者中）和再次血运重建的危险较高以及卒中危险较低相关。既往的研究结果显示，多支血管病变患者CABG后的长期死亡率低于PCI。但上述研究并未评估过采用第二代药物洗脱支架行PCI的效果。这项观察性注册研究在有多支血管病变的患者中比较了CABG与用依维莫司洗脱支架行PCI的患者转归情况。主要转归是全因死亡率。次要转归是心肌梗死、卒中和再次血运重建的比率。依维莫司洗脱支架（PCI）组和CABG组各纳入9223例患者。结果显示，平均随访2.9年时，依维莫司洗脱支架组与CABG组的死亡危险相似（分别为每年3.1% 和2.9%，HR：1.04，P=0.50），前者的心肌梗死（分别为每年1.9%和1.1%，HR：1.51，P=0.001）以及再次血运重建（分别为每年7.2% 和3.1%，HR：2.35，P0.001）危险高于后者，而PCI组的卒中危险低于CABG（分别为每年0.7% 和1.0%，HR：0.62，P0.001）。在血运重建完善的患者中，PCI组患者的心肌梗死危险并不显著高于CABG组，但在血运重建不完善的患者中这种危险差异具有显著性（P=0.02）。