Dtsch Med Wochenschr 2000; 125(48): 1475-1480
DOI: 10.1055/s-2000-8750
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© Georg Thieme Verlag Stuttgart · New York

Operation oder Angioplastie bei Koronarer Herzerkrankung - eine Zusammenfassung prospektiv randomisierter Untersuchungen

U. E. Heidland, C. J. Michel, M. P. Heintzen, B. E. Strauer
  • Medizinische Klinik und Poliklinik B (Direktor: Prof. Dr. B. E. Strauer), Heinrich-Heine-Universität Düsseldorf
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Während bei Patienten mit symptomatischer Koronarer Eingefäßerkrankung die perkutane transluminale Coronarangioplastie/Stent-Implantation das Therapieverfahren der Wahl darstellt, stehen bei Patienten mit behandlungsbedürftiger Koronarer Mehrgefäßerkrankung ohne Hauptstammstenose mit der aortokoronarvenösen Bypassoperation und der PTCA/Stent Implantation prinzipiell zwei Therapieverfahren zur Auswahl. In den letzten Jahren wurden im Rahmen großer, randomisierter Studien die Ergebnisse der katheterinterventionellen und der chirurgischen Myokardrevaskularisation verglichen [Tab. 1] [Tab. 2]. Die wesentlichen Einschlusskriterien, Studienendpunkte, Unterschiede in Bezug auf die Studienprotokolle und Patientencharakteristika sind in den [Tab. 3], [Tab. 4], [Tab. 5] zusammengefasst. Es werden im Folgenden die Ergebnisse und Limitationen der Vergleichsstudien bei koronarer Mehrgefäßerkrankung unter besonderer Berücksichtigung einer Strategie der inkompletten Revaskularisation mittels PTCA zusammengefasst.

Literatur

  • 1 Bourassa M G, Yeh W, Holubkov R. et al. for the investigators of the NHLBI PTCA registry . Long-term outcome of patients with incomplete vs complete revascularization after multivessel PTCA - a report from the NHLBI PTCA registry.  Eur Heart J. 1998;  19 103-111
  • 2 Bourassa M G, Kip E K, Jacobs A K. et al . Is a strategy of intended incomplete percutaneous transluminal coronary angioplasty revascularization acceptable in nondiabetic patients who are candidates for coronary artery bypass graft surgery?.  J Am Coll Cardiol. 1999;  33 1627-1636
  • 3 Buschmann I, Hamm C W, Reimers. et al . Five-year follow-up of angioplasty versus bypass-surgery in patients with multivessel disease (Abstract).  Eur Heart J. 1997;  18 25
  • 4 CABRI Trial Participants et al . First-year results of CABRI (coronary angioplasty versus bypass revascularization investigation).  Lancet. 1995;  346 1179-1184
  • 5 Chaitman B R, Rosen A D, Williams D O, Bourassa M G. et al. on behalf of the BARI Investigators . Myocardial infarction and cardiac mortality in the bypass angioplasty revascularization investigation (BARI) randomized trial.  Circulation. 1997;  96 2162-2170
  • 6 Cowley M J, Vandermael M, Topol E J. et al for the Multivessel Angioplasty Prognosis Study (MAPS) Group. . Is traditionally defined complete revascularisation needed for patients with multivessel disease treated by elective coronary angioplasty?.  J Am Coll Cardiol. 1993;  22 1289-1297
  • 7 Detre K M, Rosen A D, Bost J E. et al . Contemporary practice of coronary revascularization in U.S. hospitals and hospitals participating in the bypass angioplasty revascularization investigation (BARI).  J Am Coll Cardiol. 1996;  28 609-615
  • 8 Hamm C W, Kalmar P, Reimers J. et al. and the GABI Study Group . Clinical outcome and costs of CABG and PTCA in the GABI study over 2 years follow-up.  J Am Coll Cardiol. 1996;  27 712-715
  • 9 Hamm C W, Reimers J, Ischinger  T. et al for the german angioplasty bypass surgery investigation (1994) . A randomized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronary disease.  N Engl J Med. 1999;  331 037-1043
  • 10 Hampton J R. Clinical perspective - Education from RITA.  Eur Heart J. 1995;  16 878-881
  • 11 Henderson R A, Pocock S J, Sharp SJ. et al. for the randomized intervention treatment of angina (RITA-1) trial participants . Long-term results of RITA-1 trial: clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting.  Lancet. 1998;  352 1419-1425
  • 12 King S B, Barnhart H X, Kosinski A S. et al. and the EAST investigators . Angioplasty or surgery for multivessel coronary artery disease: comparison of eligible registry and randomized patients in the EAST trial and influence of treatment selection on outcomes.  Am J Cardiol. 1997;  79 1453-1459
  • 13 King S B, Lembo N J, Weintraub W S. et al . A randomized trial comparing coronary angioplasty with coronary bypass surgery.  N Engl J Med. 1994;  331 1044-1050
  • 14 Pockock S J, Henderson R A, Rickards A F. et al . Meta-analysis of randomized trials comparing coronary angioplasty with bypass surgery.  Lancet. 1995;  346 1184-1189
  • 15 Pockock S J, Henderson R A, Seed P. et al. for the RITA trial participants . Quality of life, employment status, and anginal symptoms after coronary angioplasty or bypass surgery - 3-year follow-up in the randomized intervention treatment of angina (RITA) trial.  Circulation. 1996;  94 135-142
  • 16 RITA trial participants et al . Coronary angioplasty versus coronary artery bypass surgery: the randomized intervention treatment of angina (RITA) trial.  Lancet. 1993;  341 573-580
  • 17 Rogers W J, Alderman E L, Chaitman B R. et al. and the BARI study group . Bypass angioplasty revascularization Investigation (BARI): baseline clinical and angiographic data.  Am J Cardiol. 1995;  75 9C-17C
  • 18 Rupprecht H J, Hamm C, Ischinger T. et al. on behalf of the GABI study group . Angiographic follow-up results of a randomized study on angioplasty versus bypass surgery (GABI Trial).  Eur Heart J. 1996;  17 1192-1198
  • 19 Sculpher M J, Seed P, Henderson R A. et al. for the RITA trial participants . Health service costs of coronary angioplasty and coronary artery bypass surgery: the randomized intervention treatment of angina (RITA) trial.  Lancet. 1994;  344 927-930
  • 20 The bypass angioplasty revascularization investigation (BARI) investigators et al . Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease.  N Engl J Med. 1996;  335 217-225
  • 21 The bypass angioplasty revascularization investigation (BARI) investigators et al . Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease.  Circulation. 1997;  96 1761-1769
  • 22 The writing group for the bypass angioplasty revascularization investigation (BARI) investigators et al . Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease. A multicenter randomized trial.  JAMA. 1997;  277 715-721
  • 23 Weintraub W S, Mauldin P D, Becker E. et al . A comparison of the costs of and quality of life after coronary artery disease.  Circulation. 1995;  92 2831-2840
  • 24 Weintraub W S, Stein B, Kosinski A. et al . Outcome of coronary bypass surgery versus coronary angioplasty in diabetic patients with multivessel coronary artery disease.  J Am Coll Cardiol. 1998;  31 10-19
  • 25 Zhao X Q, Brown B G, Stewart D K. et al . Effectiveness of revascularization in the emory angioplasty versus surgery trial. A randomized comparison of coronary angioplasty with bypass surgery.  Circulation. 1996;  93 1954-1962

Korrespondenz

Dr. Ulrich E. Heidland

Medizinische Klinik und Poliklinik B

Heinrich-Heine-Universität

Moorenstr. 5

40225 Düsseldorf

Phone: 0211/81-18800

Fax: 0211/81-18858

Email: heidland@med.uni-duesseldorf.de