Background:The aim of this study is to compare the long-term prognosis of non-ST elevation acute coronary syndrome (NSTE-ACS) patients with 3-vessel disease (3VD) who underwent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or medical therapy (MT).

Methods and Results:Overall, 3,928 NSTE-ACS patients with 3VD were consecutively enrolled from April 2004 to February 2011 at Fu Wai Hospital. Patients were followed up for a median of 7.5 years, and were divided into PCI, CABG or MT groups according to their treatment. Compared with patients undergoing PCI, CABG patients had lower rates of myocardial infarction (MI), unplanned revascularization, major adverse cardiovascular and cerebrovascular events (MACCE) and a higher rate of stroke (all P<0.05). Compared with MT, PCI and CABG had lower incidences of all adverse outcomes (all P<0.05), except for a similar rate of stroke between PCI and MT. Kaplan-Meier analysis showed similar results. After adjusting for confounders, CABG was independently associated with a lower risk of cardiac death, revascularization and MACCE compared with PCI (all P<0.05). Compared with MT, PCI reduced long-term risk of death, whereas CABG reduced long-term risk of death, revascularization and MACCE events (all P<0.05).

Conclusions:In NSTE-ACS patients with 3VD, CABG is independently associated with a lower risk of long-term cardiac death, revascularization and MACCE compared with PCI. Patients who received MT alone had the highest risk of long-term MACCE.

背景：本研究的目的是比较接受经皮冠状动脉介入治疗（PCI），冠状动脉搭桥术的非ST段抬高型急性冠脉综合征（NSTE-ACS）3血管疾病（3VD）患者的长期预后（CABG）或药物治疗（MT）。

方法和结果：从2004年4月到2011年2月，总共3928例NSTE-ACS 3VD的患者在富威医院连续入组。对患者进行了平均7.5年的随访，并根据治疗方法分为PCI，CABG或MT组。与接受PCI的患者相比，CABG患者的心肌梗塞（MI）发生率较低，计划外血运重建，严重的心血管和脑血管不良事件（MACCE）以及中风发生率较高（所有P <0.05）。与MT相比，PCI和CABG的所有不良结局发生率均较低（所有P <0.05），但PCI和MT之间的卒中发生率相似。Kaplan-Meier分析显示了相似的结果。校正混杂因素后，与PCI相比，CABG与心脏死亡，血运重建和MACCE的风险较低独立相关（所有P <0.05）。

结论：与PCI相比，在NSTE-ACS 3VD患者中，CABG与长期心源性死亡，血运重建和MACCE的风险较低独立相关。单独接受MT的患者长期MACCE的风险最高。