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目的:比较老年冠心病多支冠状动脉病变患者的雷帕霉素洗脱支架植入与冠状动脉旁路移植术近期与中期的疗效。方法:回顾性入选2001年12月至2005年12月,行择期血运重建的多支冠状动脉病变患者,分为冠状动脉旁路移植术组(CABG组,n=310),雷帕霉素洗脱支架植入组(SES组,n=257)。随访包括死亡、心肌梗塞(MI)、卒中和再次血运重建的主要不良心脑血管事件(MACCE)。采用Kaplan-Meier方法估计无事件生存率。采用Logistic多元回归方法调整分析治疗对终点事件的相对影响。结果:随访率96.4%。中位随访时间24个月。随访30d,CABG组MACCE的发生率高于SES组(5.8%∶1.5%,P<0.05),CABG组的死亡率高于SES组(4.7%∶1.4%,P<0.05)。至随访结束,CABG组累积死亡率仍高于SES组(6.6%∶2.9%,P<0.05),但再次血运重建率低于SES组(1.6%∶8.6%,P<0.05),MACCE两组间无差异。结论:多支冠状动脉病变患者冠状动脉旁路移植术的死亡率高于雷帕霉素洗脱支架植入,中期血运重建率低于雷帕霉素洗脱支架植入。
OBJECTIVE: To compare the short-term and long-term outcomes of rapamycin-eluting stent implantation and coronary artery bypass grafting in elderly patients with coronary artery disease and multiple coronary lesions. Methods: Retrospectively selected patients with multiple branches of coronary artery disease undergoing elective elective revascularization from December 2001 to December 2005 were divided into coronary artery bypass grafting group (CABG group, n = 310), rapamycin Eluting stent implantation group (SES group, n = 257). Follow-up included major adverse cardiac and cardiovascular events (MACCE) of death, myocardial infarction (MI), stroke, and revascularization. Kaplan-Meier method was used to estimate event-free survival. Logistic multiple regression analysis was used to adjust the relative impact of treatment on endpoint events. Results: The follow-up rate was 96.4%. The median follow-up time was 24 months. After 30 days of follow-up, the incidence of MACCE in CABG group was higher than that in SES group (5.8%: 1.5%, P <0.05). The mortality rate in CABG group was higher than that in SES group (4.7% vs 1.4%, P <0.05). At the end of follow-up, the cumulative mortality in CABG group was still higher than that in SES group (6.6% vs2.9%, P <0.05), but the rate of revascularization was lower than that in SES group (1.6% vs 8.6%, P <0.05) No difference between groups. Conclusions: The mortality of coronary artery bypass grafting in patients with multivessel coronary artery disease is higher than that of rapamycin eluting stent implantation, and the rate of mid-term revascularization is lower than that of rapamycin-eluting stent implantation.