Buszman Pawel E, Kiesz Stefan R, Bochenek Andrzej, Peszek-Przybyla Ewa, Szkrobka Iwona, Debinski Marcin, Bialkowska Bozena, Dudek Dariusz, Gruszka Agata, Zurakowski Aleksander, Milewski Krzysztof, Wilczynski Miroslaw, Rzeszutko Lukasz, Buszman Piotr, Szymszal Jan, Martin Jack L, Tendera Michal
Medical University of Silesia, Katowice, Poland.
J Am Coll Cardiol. 2008 Feb 5;51(5):538-45. doi: 10.1016/j.jacc.2007.09.054.
The purpose of this study was to compare the early and late results of percutaneous and surgical revascularization of left main coronary artery stenosis.
Unprotected left main coronary artery (ULMCA) stenting is being investigated as an alternative to bypass surgery.
We randomly assigned 105 patients with ULMCA stenosis to percutaneous coronary intervention (PCI; 52 patients) or coronary artery bypass grafting (CABG; 53 patients). The primary end point was the change in left ventricular ejection fraction (LVEF) 12 months after the intervention. Secondary end points included 30-day major adverse events (MAE), major adverse cardiac and cerebrovascular events (MACCE), length of hospitalization, target vessel failure (TVF), angina severity and exercise tolerance after 1 year, and total and MACCE-free survival.
A significant increase in LVEF at the 12-month follow-up was noted only in the PCI group (3.3 +/- 6.7% after PCI vs. 0.5 +/- 0.8% after CABG; p = 0.047). Patients performed equally well on stress tests, and angina status improved similarly in the 2 groups. PCI was associated with a lower 30-day risk of MAE (p < 0.006) and MACCE (p = 0.03) and shorter hospitalizations (p = 0.0007). Total and MACCE-free 1-year survival was comparable. Left main TVF was similar in the 2 groups. During the 28.0 +/- 9.9-month follow-up, there were 3 deaths in the PCI group and 7 deaths in the CABG group (p = 0.08).
Patients with ULMCA disease treated with PCI had favorable early outcomes in comparison with the CABG group. At 1 year, LVEF had improved significantly only in the PCI group. After more than 2 years, MACCE-free survival was similar in both groups with a trend toward improved survival after PCI.
本研究旨在比较经皮和外科手术血运重建治疗左主干冠状动脉狭窄的早期和晚期结果。
无保护左主干冠状动脉（ULMCA）支架置入术正作为旁路手术的替代方法进行研究。
我们将105例ULMCA狭窄患者随机分为经皮冠状动脉介入治疗（PCI；52例患者）或冠状动脉旁路移植术（CABG；53例患者）。主要终点是干预后12个月左心室射血分数（LVEF）的变化。次要终点包括30天主要不良事件（MAE）、主要不良心脑血管事件（MACCE）、住院时间、靶血管失败（TVF）、1年后心绞痛严重程度和运动耐量，以及总生存率和无MACCE生存率。
仅在PCI组中，12个月随访时LVEF有显著增加（PCI后为3.3±6.7%，CABG后为0.5±0.8%；p = 0.047）。两组患者在负荷试验中的表现相当，心绞痛状况改善相似。PCI与较低的30天MAE风险（p < 0.006）和MACCE风险（p = 0.03）以及较短的住院时间（p = 0.0007）相关。1年总生存率和无MACCE生存率相当。两组左主干TVF相似。在28.0±9.9个月的随访期间，PCI组有3例死亡，CABG组有7例死亡（p = 0.08）。
与CABG组相比，接受PCI治疗的ULMCA疾病患者早期预后良好。1年时，仅PCI组LVEF有显著改善。2年多后，两组无MACCE生存率相似，PCI后有生存改善趋势。
