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背景关于经皮冠状动脉介入术(PCI)和冠状动脉旁路移植术(CABG)有效性比较是持久以来关注的问题。美国心脏学会基金会(ACCF)与美国胸外科医生学会(STS)针对PCI和CABG术后长期生存率做了对照研究。方法我们结合ACCF国家心血管数据登记和STS成人心脏手术数据库,向医疗保险和医疗补助服务中心索要了2004—2008年的数据。用偏好评分和逆概率加权调整法比较结果,以减少治疗选择偏倚。结果年龄≥65岁,有2或3支冠状动脉病变,无急性心肌梗死病人中,有86 244例做了CABG术;103 549例做了PCI术。跟踪中位时间2.67年。1年,调整死亡率组间无显著差异〔CABG组6.24%,PCI组6.55%;RR=0.95,95%CI(0.90,1.00)〕。4年,CABG组比PCI组的死亡率要低〔16.4%vs.20.8%;RR=0.79,95%CI(0.76,0.82)〕。多亚组和几种不同分析法中也发现了相似结果。用敏感度分析法评价残留混杂因素。结论本观察研究发现,无需做急诊治疗多血管冠状动脉病变老年人,与PCI术比较,做CABG术的病人更具有长期生存优势。
Background The comparison of the effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) is a persistent concern. The American Heart Association Foundation (ACCF) and the American College of Thoracic Surgeons (STS) compared long-term survival after PCI and CABG. Methods We used the ACCF National Cardiovascular Data Registry and the STS Adult Cardiac Surgery Database to request 2004-2008 data from Medicare and Medicaid Services. Preference scores and inverse probability weighted adjustment method to compare the results in order to reduce treatment selection bias. RESULTS: Of the patients aged 65 years or older who had 2 or 3 coronary lesions, 86,244 did not have CABG and 103,549 did not have acute myocardial infarction. Tracing the median time 2.67 years. At 1 year, there was no significant difference between the adjusted mortality groups (CABG 6.24%, PCI 6.55%; RR 0.95, 95% CI 0.90, 1.00). Four-year mortality was lower in the CABG group than in the PCI group [16.4% vs. 20.8%; RR = 0.79, 95% CI (0.76, 0.82)]. Similar results were found in the multiple subgroups and in several different analyzes. Sensitivity Analysis Method for Evaluating Residual Confounding Factors. Conclusions This observation study found no need for emergency treatment of elderly patients with multi-vessel coronary artery disease. Compared with PCI, patients undergoing CABG have more long-term survival advantages.