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Medizinische Klinik

, Volume 93, Issue 1, pp 22–26 | Cite as

Vergleich zwischen PTCA und Bypass-Operation

Ergebnisse der großen randomisierten Studien
  • Nikolaos Dagres
  • Raimund Erbel
Übersicht

Zusammenfassung

□ Hintergrund

Die transluminale Koronarangioplastie (PTCA) und die aortokoronare Bypass-Operation sind, neben der medikamentösen Therapie, die dominierenden Therapieverfahren der koronaren Herzkrankheit. Inzwischen gibt es erste Ergebnisse vom randomisierten Vergleich der beiden Therapieformen.

□ Patienten und Methoden

Die Ergebnisse der sechs großen randomisierten Studien (GABI, RITA, CABRI, BARI, EAST und ERACI) wurden verglichen und zusammengefaßt. Einschlußkriterium war die koronare Mehrgefäßerkrankung (in RITA auch Eingefäßerkrankung), während Hauptstammstenose, vorherige PTCA oder Bypass-Operation, schwer eingeschränkte Ejektions-fraktion und Totalverschlüsse in den meisten Studien Ausschlußkriterien waren. Es wurden zwischen 127 und 1829 Patienten randomisiert. Das Follow-up betrug zwischen ein und fünf Jahre.

□ Ergebnisse

Es gab keinen signifikanten Letalitätsunterschied zwischen der PTCA- und der Bypass-Gruppe. Allein in der Subgruppe der diabetischen Patienten in der BARI-Studie war der Unterschied signifikant. Die Letalität betrug in den meisten Studien 3 bis 7%. Während die Infarktrate im Krankenhaus in der Bypass-Gruppe zum Teil signifikant höher war als in der PTCA-Gruppe, unterschied sich die Infarktrate im weiteren Follow-up nicht. In den ersten Monaten nach dem Eingriff hatten signifikant mehr Patienten Angina pectoris nach PTCA als nach Bypass-Operation. Der Unterschied nahm im Laufe der Zeit ab. Ein Jahr nach dem Eingriff waren etwa 75% der Patienten in der Bypass-und etwa 70% in der PTCA-Gruppe frei von Angina. Die Reinterventionsrate (erneute Koronarintervention oder Bypass-Operation) war in der PTCA-Gruppe mit 32 bis 54% signifikant höher als in der Bypass-Gruppe (3,2 bis 13%). Die Kosten in der Bypass-Gruppe waren signifikant höher als in der PTCA-Gruppe.

□ Schlußfolgerung

Sowohl die PTCA als auch die Bypass-Operation waren sehr effektiv in bezug auf die Angina-Behandlung ohne einen wesentlichen Unterschied in der Letalität oder der Infarktrate. Die PTCA-Patienten zeigten einen höheren Bedarf an Reinterventionen, die Kosten für ihre Behandlung war niedriger als für die Bypass-Patienten. Es bleibt abzuwarten, inwiefern die koronare Stentimplantation diese Ergebnisse wesentlich beeinflussen wird.

Schlüsselwörter

Perkutane transluminale Koronarangioplastie (PTCA) Aortokoronare Bypass-Operation Koronare Herzkrankheit 

PTCA in comparison with bypass surgery: Results of large randomized trials

Summary

□ Background

The percutaneous transluminal coronary angioplasty (PTCA) and the coronary artery bypass surgery (CABG) are established therapy modalities for the coronary artery disease. Meanwhile, first results of randomized trials comparing both therapy forms have been published.

□ Patients and Methods

The results of the 6 large randomized trials (GABI, RITA, CABRI, BARI, EAST and ERACI) were compared and summarized. Inclusion criterium was coronary multivessel disease (in RITA also one-vessel-disease). Patients with left main stem stenosis, previous PTCA or CABG, severely depressed ejection fraction and total coronary occlusions were excluded in most trials. Between 127 and 1829 patients were randomized. Follow-up was 1 to 5 years.

□ Results

There was no significant difference in mortality between the PTCA- and the CABG-group, except in the diabetic patients of the BARI trial, who showed a significantly better survival after CABG. Mortality was 3 to 7% in most trials. The rate of myocardial infarction in the follow-up did not differ significantly. The prevalence of angina was higher in the PTCA-group in the first months after the procedure, but the difference became less marked during the follow-up. One year after the procedure, approximately 75% of the patients in the CABG-group and 70% in the PTCA-group were free from angina. The rate of additional revascularization procedures was significantly higher in the PTCA-group (32 to 54%) than in the CABG-group (3.2 to 13%). Treatment costs were significantly higher in the CABG-group.

□ Conclusion

Both therapy forms were very effective concerning treatment of angina without a significant difference in mortality or frequency of myocardial infarction. The PTCA patients required more revascularization procedures, the costs for their treatment were lower than in the CABG-group. The question, whether coronary stent implantation will influence these conclusions significantly, remains open.

Key Words

Percutaneous transluminal coronary angioplasty (PTCA) Coronary artery bypass surgery (CABG) Coronary artery disease 

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Copyright information

© Urban & Vogel 1998

Authors and Affiliations

  • Nikolaos Dagres
    • 1
  • Raimund Erbel
    • 1
  1. 1.Abteilung für Kardiologie, Zentrum für Innere MedizinUniversitätsklinik-GHEssenDeutschland

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