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目的了解药物洗脱支架(DES)对首诊于心内科的冠心病患者转诊行冠状动脉搭桥术(CABG)的影响。方法入选2001年7月1日至2002年6月30日(BMS 时代)以及2003年7月1日至2004年6月30日(DES 时代)首诊于北京安贞医院心内科并接受经皮冠状动脉介入(PCI)或冠状动脉搭桥(CABG)的2598例患者,分析 BMS 时代与 DES 时代患者转行 CABG 术的临床及冠状动脉病变特征,评价 DES 对转诊 CABG 治疗的影响。结果 DES 时代1333例(80.1%)患者接受 PCI 治疗,331例(19.9%)患者转行 CABG 术,BMS 时代721例(77.2%)患者接受 PCI 治疗,213例(22.8%)患者转行 CABG 术,转诊率下降约12.7%。与 BMS 时代相比,DES 时代左主干病变(1.4%比3.2%,P=0.025)前降支近端(39.8%比44.2%,P=0.047)与弥漫长病变患者(11.2%比19.7%,P=0.021)接受 PCI 治疗的比例明显增加,但无论是否置入 DES,左主干病变、慢性闭塞病变、前降支近段病变以及开口病变的患者仍是接受 CABG 治疗的最常见冠状动脉病变类型。DES 时代接受 PCI治疗的患者再次血管重建率明显低于 BMS 时代(12.7%比7.1%,P<0.001)。多变量 Logistic 分析显示,病变血管支数、左主干病变、慢性闭塞病变以及前降支近端病变是选择 CABG 的主要预测因素。结论 DES 对冠心病患者血管重建方式及策略产生了一定的影响,在非 DES 时代需要转诊行 CABG治疗的冠状动脉病变,在 DES 时代接受 PCI 治疗置入 DES。
Objective To investigate the effect of drug-eluting stent (DES) on coronary artery bypass grafting (CABG) in patients with coronary heart disease who were first diagnosed as cardiology. Methods The patients were admitted to the Department of Cardiology of Beijing Anzhen Hospital from July 1, 2001 to June 30, 2002 (BMS era) and July 1, 2003 to June 30, 2004 (DES era) To investigate the clinical and coronary lesion characteristics of patients undergoing CABG in the BMS era and DES era and to evaluate the impact of DES on the CABG in the treatment of 2598 patients with coronary artery disease (PCI) or coronary artery bypass graft (CABG). Results In the DES era, 1333 patients (80.1%) were treated with PCI. CABG was performed in 331 patients (19.9%) and in 721 patients (77.2%) in the BMS era. 213 patients (22.8% The clinic rate dropped by about 12.7%. Compared with the BMS era, patients with diffuse lesions (11.2% versus 19.7%, 39.8% vs. 44.2%, P = 0.047) had a significant reduction in left main lesions (1.4% vs. 3.2%, P = 0.025) P = 0.021). However, patients with left main disease, chronic occlusive disease, proximal anterior descending artery disease, and open lesions were the most common type of coronary artery lesions undergoing CABG treatment with or without DES . The rate of revascularization in patients undergoing PCI during the DES era was significantly lower than in the BMS era (12.7% vs. 7.1%, P <0.001). Multivariate Logistic analysis showed that vessel count, left main trunk, chronic occlusion and proximal anterior descending artery were the main predictors of CABG selection. Conclusions DES has a certain influence on the methods and strategies of vascular reconstruction in patients with coronary heart disease. In the non-DES era, coronary artery lesions requiring CABG referral were treated with DES.