초록접수 현황
| 15F-151 | 구연 발표 |
Long-term Survival Advantage of Off-pump Coronary Artery Bypass Grafting Versus First Generation Drug-eluting Stenting
이기종¹, 윤영남², 임선희², 유경종²
연세대학교 의과대학 강남세브란스병원 흉부외과교실¹ 연세대학교 의과대학 세브란스병원 흉부외과학교실²
Background : Few randomized controlled trials and huge-volume registry data showed survival advantage of surgical coronary revascularization against drug-eluting stent (DES) implantation. The purpose of this study is to identify the survival advantage of off-pump coronary artery bypass grafting (OPCAB) during the first generation DES era (2003-2008).
Methods : 1420 propensity score matched patients (710 OPCAB versus 710 DES) with triple vessel coronary disease were analyzed. Primary study end point was all-cause mortality. Secondary study end points were cardiac death, cardiovascular death, and major adverse cardiac and cerebrovascular event (MACCE). We defined cardiac death and cardiovascular death as they were in 2014 ACC/ACCF clinical data standards. Information on death was assessed from the database of National Statistical Office.
Results : Follow-up duration was 84 months (0-144 months). Survival follow-up was completed in 100% of patients. All-cause mortality was 19.4% in OPCAB group and 29.9% in DES group (p<0.001). Cardiovascular death and cardiac death were observed in 7.9% and 6.2% of OPCAB group and 13.0% and 9.7% in DES group (p=0.002, p=0.014). Overall MACCE rate was 30.6% in OPCAB group and 50.0% in DES group (p<0.001). 10-year cardiac-survival was 92.5±1.1% in OPCAB group and 87.1±1.6% in DES group (p=0.016 by log-rank test).
Conclusion : After a mean of 7 years follow-up, surgical revascularization showed better overall survival, cardiovascular survival, and cardiac survival as well as MACCE-free survival in triple-vessel coronary artery disease patients. At 10 years, OPCAB group showed 5% cardiac-survival advantage compared with the first generation DES group.
Methods : 1420 propensity score matched patients (710 OPCAB versus 710 DES) with triple vessel coronary disease were analyzed. Primary study end point was all-cause mortality. Secondary study end points were cardiac death, cardiovascular death, and major adverse cardiac and cerebrovascular event (MACCE). We defined cardiac death and cardiovascular death as they were in 2014 ACC/ACCF clinical data standards. Information on death was assessed from the database of National Statistical Office.
Results : Follow-up duration was 84 months (0-144 months). Survival follow-up was completed in 100% of patients. All-cause mortality was 19.4% in OPCAB group and 29.9% in DES group (p<0.001). Cardiovascular death and cardiac death were observed in 7.9% and 6.2% of OPCAB group and 13.0% and 9.7% in DES group (p=0.002, p=0.014). Overall MACCE rate was 30.6% in OPCAB group and 50.0% in DES group (p<0.001). 10-year cardiac-survival was 92.5±1.1% in OPCAB group and 87.1±1.6% in DES group (p=0.016 by log-rank test).
Conclusion : After a mean of 7 years follow-up, surgical revascularization showed better overall survival, cardiovascular survival, and cardiac survival as well as MACCE-free survival in triple-vessel coronary artery disease patients. At 10 years, OPCAB group showed 5% cardiac-survival advantage compared with the first generation DES group.
책임저자: 유경종
연세대학교 의과대학 세브란스병원 흉부외과학교실
연락처 : 이기종, Tel: 02-2019-3382 , E-mail : gijongyi@yuhs.ac
