Ng Martin K C, Yeung Alan C
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, USA.
Rev Cardiovasc Med. 2005 Fall;6(4):187-93.
Severe stenosis of the left main coronary artery (LMCA) is a coronary artery-disease manifestation of critical prognostic importance. As a consequence of the survival advantage conferred by coronary artery bypass grafting (CABG) over medical therapy, lesions in the LMCA have been considered a standard indication for CABG for nearly 3 decades. Initial attempts to treat LMCA disease percutaneously by balloon angioplasty resulted in poor clinical outcomes, leading many to regard significant LMCA disease as a contraindication for percutaneous coronary intervention (PCI). However, the development and refinement of coronary stenting over the last 15 years, followed by the recent introduction of drug-eluting stents, has fueled renewed interest in percutaneous treatment of LMCA disease. Outcomes of recent studies using sirolimus- and/or paclitaxel-eluting stents for treatment of LMCA disease have yielded rates of in-hospital and 1-year mortality that compare favorably with those of surgery. This article will review the natural history of LMCA disease, the outcomes of CABG for LMCA disease, and the history and recent developments regarding PCI for LMCA disease.
左冠状动脉主干（LMCA）严重狭窄是一种具有关键预后重要性的冠状动脉疾病表现。由于冠状动脉旁路移植术（CABG）相对于药物治疗具有生存优势，近30年来，LMCA病变一直被视为CABG的标准适应证。最初尝试通过球囊血管成形术经皮治疗LMCA疾病导致了较差的临床结果，使得许多人将严重的LMCA疾病视为经皮冠状动脉介入治疗（PCI）的禁忌证。然而，在过去15年中冠状动脉支架的发展与完善，以及近期药物洗脱支架的引入，重新激发了人们对经皮治疗LMCA疾病的兴趣。最近使用西罗莫司和/或紫杉醇洗脱支架治疗LMCA疾病的研究结果显示，住院死亡率和1年死亡率与手术相当。本文将综述LMCA疾病的自然病程、CABG治疗LMCA疾病的结果以及LMCA疾病PCI的历史和近期进展。
