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

PercutaneousorSurgicalRevascularizationforMultivesselCoronaryArteryDisease? VergheseMathew,MD,FACC Consultant,DivisionofCardiovascularDiseasesandDepartmentofRadiology ProfessorofMedicine,MayoClinicCollegeofMedicine  Revascularization Strategies How do we decide? Anatomy Clinical Patient presentation preference Risk vs. Benefit Invasive Therapies Low Risk Patient High Risk Patient Some acute risk Less long-term risk reduction Greater acute risk Greater long-term risk reduction 12-Year Survival in Patients with CAD 50 35-49 35 Emond M et al: Circ 90:2645, 1994 23,467 Medically-Treated Patients in CASS Registry LVEF CP1203018-2 12-Year Survival in Patients with CAD No CAD 1 vessel 2 vessel 3 vessel Emond M et al: Circ 90:2645, 1994 23,467 Medically-Treated Patients in CASS Registry CP1203018-1 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 CP1203018-14 Extension of survival (mo) Yusuf S et al:Lancet 344:563, 1994 Overall Vessel disease 1/2 vessels 3 vessels Left main LV function NormalAbnormal Exercise test NormalAbnormal Angina Class 0, I, II Class III, IV Low Moderate High Low Moderate High VA risk score Stepwise risk score CABG vs Stenting for MVD Meta-Analysis of ARTS, ERACI-II, MASS-II and SOS Circ 118, 2008 Days Event-Free Survival Analysis of Death 1,518 1,472 1,456 1,440 1,406 1,347 1,533 1,479 1,457 1,439 1,412 1,349 Overall survival (%) P=0.78 Days Repeat Revascularization 1,518 1,204 772 740 707 665 1,533 1,428 927 911 882 855 P0.0001 Overall survival (%) Days Death, Stroke or MI 1,518 1,381 913 896 872 846 1,533 1,377 908 891 868 845 Overall survival (%) P=0.64 Days Major Adverse Cardiac and Cerebrovascular Events 1,518 1,153 729 691