摘要目的 比较冠心病左主干和多支血管病变患者接受非体外循环冠状动脉旁路移植术(OPCABG)或经皮冠状动脉介入治疗(PCI)后1年内生活质量改善的情况.方法 本研究为前瞻性研究,连续入选首都医科大学附属北京安贞医院2018年1至7月期间,840例接受再血管化治疗的复杂冠心病患者,年龄(61±9)岁,男性占74％(622/840).其中420例行OPCABG,另外420例行PCI治疗.使用欧洲五维健康量表(EQ-5D)和西雅图心绞痛量表(SAQ)评估患者的生活质量和健康状况.对患者术后1、6和12个月的生活质量进行评估.结果 经逆概率加权法(IPW)调整后1年的全因死亡(3.6％比1.3％,P=0.045),主要不良心脑血管事件(MACCE)(11.3％比4.1％,P＜0.001)和再次血运重建率(8.3％比1.2％,P＜0.001)PCI组均高于OPCABG组.术后1个月PCI组EQ-5D评分高于OPCABG组(P＜0.001),术后6个月略低于OPGABG组(P=0.035),但术后12个月两组差异无统计学意义(P=0.210).在SAQ量表中,OPCABG组的心绞痛发作频率评分在术后1、6和12个月均高于PCI组(均P＜0.05);躯体活动受限程度评分,术后1个月PCI组高于OPCABG组(P＜0.01);心绞痛稳定状态、治疗满意程度和对疾病的认识方面,OPCABG组和PCI组差异无统计学意义(均P＞0.05).结论 冠心病左主干和多支血管病变患者中,接受OPCABG治疗的患者术后短期内生活质量改善情况优于PCI组,但中长期的生活质量改善情况仍需随访.

abstractsObjective To compare the improvement of quality of life in the patients with left main coronary artery disease and multi-vessel disease between off-pump coronary artery bypass grafting (OPCABG) and percutaneous coronary intervention (PCI) within one year after revascularization.Methods This study was a prospective study.Between January and July 2018,840 patients with complex coronary heart disease accepted revascularization therapy,420 of whom underwent OPCABG and 420 for PCI,with a mean age of 61 years and a male rate of 74％ (622/840).European Quality of Life-5 Dimensions (EQ-5D) and Seattle Angina Questionnaire (SAQ) were employed to assess the quality of life and health status of patients.Inverse probability weighting (IPW) was used to adjust treatment selection bias.Results All-cause mortality (3.6％ vs 1.3％,P=0.045),major adverse cardiac and cerebrovascular events (MACCE) (11.3％ vs 4.1％,P＜0.001) and target lesion revascularization (8.3％ vs 1.2％,P＜0.001) were higher in PCI group than those in OPCABG group.EQ-5D scores in PCI group were significantly higher than those in OPCABG group at 1 month after operation (P＜0.001),but there was no significant difference between the two groups at 12 months after operation (P=0.210).In SAQ scale,the frequency score of angina pectoris in OPCABG group was higher than that in PCI group in 1 month,6 months and 12 months after operation (all P＜0.05).The physical activity limitation score in PCI group was significantly higher than that in OPCABG group at one month after operation (P＜0.01).There was no significant difference between OPCABG group and PCI group in terms of stable state of angina pectoris,satisfaction of treatment and the knowledge of disease.Conclusions In the short term,the quality of life of patients with left main coronary artery disease and multi-vessel disease treated with OPCABG is better than PCI.However,the improvement of quality of life in the medium and long term still needs to be identified in future follow-up study.