对照冠状动脉旁路移植和皮肤冠状动脉干预在八岁以上的人与左主或多血管疾病之间的结果
Hristo Kirov1, Tulio Caldonazo1, Leoni Lu Riedel1
1Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany.
Scientific reports
|December 15, 2023
概括
冠状动脉旁路移植 (CABG) 在患有复杂冠状动脉疾病的八十多岁人群中,比皮肤冠状动脉干预 (PCI) 提供了长期生存益处. 虽然CABG减少了晚期死亡率和重新干预,但它具有更高的初始手术风险.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 心脏外科手术 心脏外科手术
背景情况:
- 冠状动脉旁路移植 (CABG) 和皮肤冠状动脉干预 (PCI) 是冠状动脉疾病 (CAD) 的主要重血管化策略.
- CABG的机制涉及手术附带担保,可能防止未来的心肌梗塞 (MI) 并延长寿命.
- 在八十岁以上的人群中,CABG与PCI的比较有效性,这是一个被认为有更高的外科风险的人群,仍在争论中.
研究的目的:
- 为了比较CABG和PCI的长期结果,八十多岁的左主或多血管冠状动脉疾病.
- 为了评估两种手术之间晚期死亡率,外科手术期间死亡率,心肌梗塞,再血管化,急性功能衰竭和中风的差异.
主要方法:
- 进行了一项元分析,汇集了包括17942名患者在内的14项研究的数据.
- 主要结局是晚期死亡率 (大于5年);次要结局包括术后死亡率,心脏病发作,再血管化 (R-R),急性功能衰竭 (ARF) 和中风.
- 进行了聚合的卡普兰-梅尔和里程碑分析,以评估随时间的生存差异.
主要成果:
- CABG与显著降低晚期死亡率 (HR:1.23,P < 0.01) 和在长期随访期间降低死亡风险 (HR:1.08,P = 0.005) 相关.
- 里程碑式的分析证实了CABG在21.5个月后的生存优势,但PCI在30天内显示出早期优势 (HR:0.72,P < 0.0001).
- CABG显示MI和R-R的风险较低,但与更高的术后死亡率有关;ARF和中风没有显著差异.
结论:
- 在患有复杂冠状动脉疾病的八十多岁人群中,CABG在长期存活方面似乎优于PCI.
- 这种CABG的生存益处与心肌梗塞和重复血管化事件的减少有关.
- CABG的优势是随着外科手术期间死亡风险的增加而增加,需要仔细选择患者.
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