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【medical-news】左主干病变支架与外科手术比较
Heart 2008;94:1244-1246
The MAIN-COMPARE registry (Revascularisation for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularisation) compared the long-term outcomes of coronary stent implantation (percutaneous coronary intervention (PCI), n = 1102) and coronary artery bypass grafting (CABG, n = 1138) in patients with unprotected left main stem disease in Korea. Patients from 12 major cardiac centres were enrolled between January 2000 and June 2006. Patients underwent PCI instead of CABG either because of patient or doctor preference or where CABG was felt to be high risk. From January 2000 to May 2003 stenting was performed exclusively with bare metal stents (BMS; wave 1) and from May 2003 to June 2006 with drug-eluting stents (DES; wave 2). Patients were followed up at 1 month, 6 months and 1 year and then annually. Routine angiographic follow-up was recommended for all patients who underwent PCI, 6–10 months after the index procedure. However, patients deemed at high risk for angiographic complications and who had no symptoms or signs of ischaemia (and those who declined) did not undergo this. In the CABG arm, angiographic follow-up was only recommended if the patients were symptomatic. The end points of the study were death; the composite of death, myocardial infarction or stroke; and target vessel revascularisation. The two arms were propensity score matched as well as the subgroups for type of stent.
In the overall cohort there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio (HR) for the stenting group = 1.18, 95% CI 0.77 to 1.80) or the risk of composite outcome (HR = 1.10, 95% CI 0.75 to 1.62). The rates of target vessel revascularisation were significantly higher in the group who received stents than in the group who underwent CABG (HR = 4.76, 95% CI 2.80 to 8.11). A comparison of the BMS subgroup with the CABG group and the DES subgroup with CABG showed similar results, although there was a trend towards higher rates of death and the composite end point in the group who received DES.
This was an observational study and therefore treatment strategy was not randomised but left to the discretion of the individual doctor or the patient. The findings are subject to selection bias and confounding, which will have been minimised but not eliminated by propensity score matching. Although the rate of repeat revascularisation was lower with DES than BMS, CABG was still more effective at reducing this. However, since there was a significantly higher rate of follow-up angiography in the PCI arm (73% vs 14.6%, p<0.001), the rate of asymptomatic graft stenosis or occlusion may have been underestimated. The study was underpowered to detect significant differences in mortality, especially in the comparison between DES and CABG. There remains a compelling case for a randomised trial to assess the efficacy of these two treatments, although this should be designed to inform management decisions for individual patients and not become a competition with the aim of identifying a "superior" technology. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 。 Stenting versus surgery in left main stem disease
支架与手术在左主干疾病中的对比
Heart 2008;94:1244-1246
《心脏》2008；第94卷：1244-1246
The MAIN-COMPARE registry (Revascularisation for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty versus Surgical Revascularisation) compared the long-term outcomes of coronary stent implantation (percutaneous coronary intervention (PCI), n = 1102) and coronary artery bypass grafting (CABG, n = 1138) in patients with unprotected left main stem disease in Korea. Patients from 12 major cardiac centres were enrolled between January 2000 and June 2006. Patients underwent PCI instead of CABG either because of patient or doctor preference or where CABG was felt to be high risk. From January 2000 to May 2003 stenting was performed exclusively with bare metal stents (BMS; wave 1) and from May 2003 to June 2006 with drug-eluting stents (DES; wave 2). Patients were followed up at 1 month, 6 months and 1 year and then annually. Routine angiographic follow-up was recommended for all patients who underwent PCI, 6–10 months after the index procedure. However, patients deemed at high risk for angiographic complications and who had no symptoms or signs of ischaemia (and those who declined) did not undergo this. In the CABG arm, angiographic follow-up was only recommended if the patients were symptomatic. The end points of the study were death; the composite of death, myocardial infarction or stroke; and target vessel revascularisation. The two arms were propensity score matched as well as the subgroups for type of stent.
MAIN-COMPARE登记薄（对无防备的左主冠状动脉狭窄血管形成术：比较经皮冠状动脉血管成形术和外科血管成形术）比较了韩国发生无防备的左主干疾病的患者接受冠脉支架置入术和冠状动脉搭桥术的远期结果，其中经皮冠状动脉介入（PCI）1102例，冠状动脉搭桥术（CABG）1138例。从2000年1月到2006年6月来源于12个主要心脏中心的患者被纳入。做PCI而不是CABG的患者既不是因为患者或医生更偏爱也不是CABG被认为有更高的风险。从2000年1月到2003年5月全部使用裸金属支架（BMS;波形1），从2003年5月到2006年6月使用药物洗脱支架（DES;波形2）。患者在1个月、6个月和1年分别随访一次，以后每年随访一次。常规的血管造影术的随访推荐所有行PCI的患者在指数程序后随访6-10个月。然而，注定在发生血管造影的合并症方面处于高风险的患者和那些没有缺血症状或体征（和那些下倾的患者）不行PCI。在CABG组，血管造影的随访只在患者有症状时才被推荐。该研究的终点是死亡；混合死亡，心肌梗死或者中风和靶血管的血管形成术。两方面的倾向得分与支架类型的亚群一样。
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作者:admin@医学,生命科学 2010-11-02 22:43
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