| Background and ObjectiveWith the development of the society, people's life style is also changing, coronary heart disease(coronary heart diseases, CHD) higher morbidity and mortality, serious threat to human health and quality of life, have different clinical phenotypes of the disease, the disease in recent years tend to be divided into acute coronary syndrome, acute coronary syndrome, ACS) and chronic coronary artery disease(chronic coronary artery diseases, CAD).ACS is coronary atherosclerosis plaque rupture or attack, secondary complete or incomplete occlusive thrombosis as the pathological basis of a group of clinical syndromes, including acute ST-elevation myocardial infarction(ST-segment elevation myocardial infarction, STEMI), acute non-ST-segment elevation myocardial infarction(non-ST-segment elevation myocardial infarction, NSTEMI) and unstable angina.(unstable angina, UA). multi-vessel diseases(multi-vessel diseases, MVD) is always a difficult problem to clinical treatment, considering the clinical criteria of percutaneous coronary intervention is a degree of coronary stenosis of 75% or more, MVD was defined as at least two main coronary blood vessels or its main branches diameter stenosis degree of 75% or higher.Acute myocardial is chemia is one of the key steps in clinical emergency patients with ACS caused, the current treatment is quickly recover myocardial blood supply, now used in clinical drug treatment, percutaneous coronary intervention(percutaneous coronary intervention, PCI) therapy and coronary artery bypass surgery(coronary artery bypass graft, CABG) is the main three treatment methods.Drug therapy is the basis of the comparison of traditional treatment methods, mainly including antiplatelet drugs, ?-receptor blockers, angiotensin converting enzyme inhibitors(ACEI), anticoagulants, lipid, etc.Internal PCI treatment by the earliest clinical application of percutaneous balloon coronary angioplasty(PTCA), in 1987 to develop for percutaneous coronary artery stent implantation(percutaneous coronary intervention, PCI) and coronary artery stents for the earliest application of bare-metal stents(bare metal stents BMS) by the year 2002 for the development of application of drug-eluting stents(DES)(drug eluting stents DES), also called drug-coated stents, effectively reduce the restenosis, at the same time it can make the endothelial process delay, so compared with bare stents high incidence of stent thrombosis, traumatic minimum intervention in the blood supply revascularization, current clinical PCI therapy refers to coronary stent implantation.CABG or coronary artery bypass surgery, also called coronary artery bypass surgery or bypass surgery.In 1964, Garrot autogenous great saphenous vein transplantation in the ascending aorta and coronary artery stenosis segment between the distal, success, transplanted vein after seven years is still open.By 1967, Favaloro repetition and further promote in the clinical applications of coronary artery bypass graft surgery.In patients with acute coronary syndrome(ACS) vascular lesions more what treatment method is used to achieve the best treatment condition has been controversial, this study aims to compare three methods of treatment in the clinical curative effects in the long run. Method725 patients treated with the above three therapies were followed up after being discharged from May 2015 through December 2015,coronary angiography and other relevant clinical date were collected.Clinical endpoints were documented. The primary endpoint was all cause death and the second endpoints were myocardial infarction, retreatment of percutaneous coronary intervention(PCI) or CABG and readmission due to angina, heart failure and stroke. Univariate analysis and multivariate Cox proportional hazards regression model were used to explore the prognostic factors of coronary artery disease. Kaplan-Meier survival curve was utilized to compare the survival rate of the three treatments. P<0.05 was considered to be of statistical significance. Results1.655 subjects completed the(30.6±5.5) months of follow-up, with 177 cases of endpoints(27.0%) and 33 cases of death(5.0%).2.The incident rate of blood supply reconstruction and angina pectoris and the total endpoint in the PCI group was lower than that in drug therapy group(2.3%,8.8%,20.7%,P<0.05). The incident rate of blood supply reconstruction and the total endpoint in CABG group was lower than that in drug therapy group(1.9%,22.4%,P<0.001). Three groups of case mortality, myocardial infarction rate, because of differences in stroke and heart failure readmission rate had no statistical significance.3.Multivariate Cox proportional hazards regression analysis revealed that age,hypertension,no taking ACEI,statins are risk factors of the endpoint(P > 0.05).4.The Kaplan Meier survival curve analysis showed the cumulative survival rate of non-endpoint rate in the three groups was statistical difference(P=0.014). ConclusionFor multipie vascular lesions in patients with acute coronary syndrome,three treatment methods of case fatality rate is similar.The incidence rate of revascularization and angina pectoris or total end point events of interventional therapy is lower than that of drug therapy. The incident rate of blood supply reconstruction and the total endpoint of CABG group was lower than that of drug therapy group. |
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