对多支血管的冠心病选择经皮血管成形术或者外科手术的血管成形术_Verghes英.pptVIP

Percutaneous or Surgical Revascularization for Multivessel Coronary Artery Disease? Verghese Mathew, MD, FACC Consultant, Division of Cardiovascular Diseases and Department of Radiology Professor of Medicine, Mayo Clinic College of Medicine Revascularization Strategies 12-Year Survival in Patients with CAD 12-Year Survival in Patients with CAD Clinical Presentation Age Acute ischemic syndrome versus chronic stable angina Prior cardiac history (MI, CABG, intervention) Co-morbid conditions (diabetes, cerebrovascular disease, renal disease, lung disease) Functional impairment Ischemic burden Extension of Survival with CABG vs Medical Therapy After 10 Years CABG vs Stenting for MVD Meta-Analysis of ARTS, ERACI-II, MASS-II and SOS Increased Likelihood of Restenosis Lesion/Patient Subsets Small vessels Bifurcations Ostial CTO Bare metal ISR SVG AMI (thrombus) Diabetes mellitus CABG vs Drug-Eluting Stents in Multivessel Coronary DiseaseA Meta-Analysis on 24,268 Patients SYNTAX: Outcomes SYNTAX CABG/PCI Registries Outcomes Stratified by SYNTAX Score Procedural Differences Between SYNTAX CABG Randomized vs Registry CABG RCT CABG registry Variable n=897 n=644 Complete revasc (%) 63.2 (550/870) 74.7 (481/644) Graft revascularization (%) At least 1 arterial graft 97.3 (831/854) 96.7 (623/644) Arterial graft to LAD 95.6 (816/854) 94.7 (610/644) Double LIMA/RIMA 27.6 (236/854) 16.1 (104/644) Complete arterial 18.9 (161/854) 11.2 (72/644)  revascularization Venous grafts only 2.6 (22/854) 3.3 (21/644) Procedural Differences Between SYNTAX PCI Randomized Cohort and the PCI Registry PCI RCT PCI registry Variable n=903 n=192 Complete revasc (%) 56.7 (508/896) 36.5 (70/192) Lesions, no. (mean ± SD) 4.4±1.8 4.5±1.8 Stents implanted 4.6±2.3 3.1±1.8(mean ± SD) Total length implanted, 86.1±47.9 58.5±41.2mean ± SD (mm) Range (mm) 8.0-324.0 8.0-252.0 Long stenting 33.2 (291/877) 12.2 (23/188)(100 mm) (%) SYNTAXStent Thrombosis and Symptomatic Graft Occlusion Per