医心网 > 独家资讯 > 正文

[TCT2008]支架术与冠脉搭桥在无保护左主干病变中的效果相当

发布于:2008-10-16 08:57

支架术与冠脉搭桥在无保护左主干病变中的效果相当

Stenting and CABG Equivalent for Survival in Unprotected Left Main Disease

（北京协和医院鲁勖翻译）

关键词:

• 韩国MAIN-COMPARE注册研究显示：冠脉搭桥术的无TVR生存率更高.

根据韩国Catholic University大学St. Mary’s医院的Ki-Bae Seung等进行的研究，冠脉搭桥术在降低TVR率上比支架术更有效。此份研究是一个为期三年注册研究，名为MAIN-COMPARE。

最终结果显示在总共542名患者中，支架术与冠脉搭桥术对三年累积生存率没有显著性差异。与此类似，支架术与冠脉搭桥术对死亡，Q波心梗和中风的影响也没有显著性差异。但是，二者在三年期的无TVR生存率上存在显著区别，结果显示如下图。

覆膜支架与冠脉搭桥

在总共396名药物释放支架和冠脉搭桥的对比中，死亡率在两组间没有显著性差异，另外，联合死亡率，Q波心梗和中风在两组间也没有差异。入选的患者均有无保护左主支病变，并接受支架术或冠脉搭桥治疗。如果患者以前曾行冠脉搭桥术，伴发瓣膜疾病或主动脉手术，STEMI或心源性休克历史，都会被排除在入组范围外。

CABG vs. DES at Cedars-Sinai

在另一个中心进行的冠脉搭桥和PCI术比较研究中，来自洛杉矶Cedars-Sinai医学中心的Raj R. Makkar教授对343名无保护左主干病变患者进行了研究。其中120名采用药物释放支架，223名接受了冠脉搭桥术。其结果显示，PCI术比冠脉搭桥术的长期生存率更低，在采用Parsonnet评分法的测定中，得分大于15的患者其PCI术生存率尤其低。

Parsonnet得分小于15的患者其冠脉搭桥和PCI术的生存率基本相当，主要不良心脏事件和脑血管事件发生率则在PCI组中明显偏低。这份研究的平均随访期在PCI患者群中为973天，冠脉搭桥患者群为298天。

（来源：www.tctmd.com）

Stenting and CABG Equivalent for Survival in Unprotected Left Main Disease

Key Points:

• Korean MAIN-COMPARE Registry: Higher TVR-free survival rates with CABG.

CABG remained more effective in reducing TVR than stenting, according to three-year data from the MAIN-COMPARE Registry presented by Ki-Bae Seung, MD, PhD, from The Catholic University of Korea, Kangnam St. Mary’s Hospital.
Outcomes of the propensity-matched cohort (n=542) comparing stenting vs. CABG showed no statistically significant difference in cumulative survival at three years.

Similarly, no statistically significant difference was found between stenting and CABG for death, Q-wave MI, or stroke. However, the three-year difference between stenting and CABG for TVR-free survival was statistically significant in favor of CABG (see Figure 1).

DES vs. CABG

Among outcomes of the propensity-matched cohort (n=396) comparing DES vs. CABG, the mortality difference between the two modalities was not statistically significant. Neither was the difference between DES and CABG in the combined outcome of death, Q-wave MI,or stroke.

Patients included in the study had unprotected LMCA disease (.50% by visual estimation) and underwent stenting or isolated CABG. Patients were excluded if they had prior CABG, concomitant valvular or aortic surgery, STEMI, or cardiogenic shock at presentation.

CABG vs. DES at Cedars-Sinai

In another presentation on efficacy of CABG vs. PCI for unprotected left main disease, Raj R. Makkar, MD, director of interventional cardiology and the cardiac catheterization lab at the Cedars-Sinai Medical Center in Los Angeles, reported data analyzing 343 consecutive patients (DES, n=120; CABG, n=223) at his institution.

The unadjusted long-term survival rates were significantly lower for PCI compared with CABG (P<.005). When stratified according to Parsonnet score, survival was significantly lower for PCI vs. CABG (P<.017) in patients with scores .15.
Survival in patients with Parsonnet scores <15 was equivalent between CABG and DES; major adverse cardiac and cerebrovascular event-free survival also was significantly lower with PCI regardless of the Parsonnet score (P=.001 for score .15, P=.02 for score ,15).

Among propensity-matched patients (n=134), survival (P=.72) and major adverse event-free survival (P =.17) were similar between the two groups (see Figure 2).

Mean duration of follow-up for PCI was 973 days and for CABG, 298 days.

Disclosures:
• Dr. Makkar reports no relevant conflicts of interest.
• Dr. Seung reports no relevant conflicts of interest.

来源：医心网

上一篇：重磅｜中国自主研发心血管OCT系统正式上市助力PCI精准治疗

下一篇：[TCT2008]DES降低医保患者的再血管化发生率

相关文章: