关于经皮冠状动脉介入术与冠状动脉搭桥术治疗冠心病患者的成本效益的临床研究进展

摘要

冠心病是心血管疾病的常见病之一,虽然当前的临床技术日新月异,但对合并左主干或多支血管病变患者,是选择冠状动脉搭桥术(CABG)还是经皮冠状动脉介入术(PCI)仍有争议.对于PCI和CABG术后短期1年内的成本效益,目前仍有争议.对于PCI和CABG术后5年及以上的长期成本效益来说,近年来的临床研究证实CABG虽然花费更高,但其在预期寿命、质量调整生命年、主要不良心脑血管事件发生率和心肌梗死、死亡及卒中的趋势上优于PCI.对于合并糖尿病的多支病变冠心病患者,PCI后有更频繁的重复血运重建,而CABG更能改善患者的生活质量、增加质量调整生命年.%Coronary heart disease is a common disease of cardiovascular disease .Although the current clinical technology are rapidly changing,for patients with left main disease or multivessel disease ,selecting coronary artery bypass grafting (CABG) or percutaneous coronary intervention(PCI)is still controversial.As well,after 1-year follow-up,the short-term cost-effectiveness of PCI and CABG is still controver-sial.In consideration of the long-term cost-effectiveness of PCI and CABG after 5-year follow-up,the recent clinical studies confirm that CABG is more expensive,but it has better life expectancy and quality of life.In addition,it has less incidence of main adverse cardiovascular and cerebrovascular events,myocardial infarction,stroke and death compared with PCI.For multivessel patients with diabetes mellitus,PCI has frequent revascularization post surgery,and CABG can improve the quality of life and increase quality-adjusted life years.