Department of Cardiology, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Am Coll Cardiol. 2010 Jul 6;56(2):117-24. doi: 10.1016/j.jacc.2010.04.004. Epub 2010 May 6.
We performed the long-term follow-up of a large cohort of patients in a multicenter study receiving left main coronary artery (LMCA) revascularization.
Limited information is available on long-term outcomes for patients with unprotected LMCA disease who underwent coronary stent procedure or coronary artery bypass grafting (CABG).
We evaluated 2,240 patients with unprotected LMCA disease who received coronary stents (n = 1,102; 318 with bare-metal stents and 784 with drug-eluting stents) or underwent CABG (n = 1,138) between 2000 and 2006 and for whom complete follow-up data were available for at least 3 to 9 years (median 5.2 years). The 5-year adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction [MI], or stroke; and target vessel revascularization [TVR]) were compared with the use of the inverse probability of treatment weighted method and propensity-score matching.
After adjustment for differences in baseline risk factors with the inverse probability of treatment weighting, the 5-year risk of death (hazard ratio [HR]: 1.13; 95% confidence interval [CI]: 0.88 to 1.44, p = 0.35) and the combined risk of death, Q-wave MI, or stroke (HR: 1.07; 95% CI: 0.84 to 1.37, p = 0.59) were not significantly different for patients undergoing stenting versus CABG. The risk of TVR was significantly higher in the stenting group than in the CABG group (HR: 5.11; 95% CI: 3.52 to 7.42, p < 0.001). Similar results were obtained in comparisons of bare-metal stent with concurrent CABG and of drug-eluting stent with concurrent CABG. In further analysis with propensity-score matching, overall findings were consistent.
During 5-year follow-up, stenting showed similar rates of mortality and of the composite of death, Q-wave MI, or stroke but higher rates of TVR as compared with CABG for patients with unprotected LMCA disease.
我们对一项多中心研究中接受左主干冠状动脉（LMCA）血运重建的大量患者进行了长期随访。
接受冠状动脉支架术或冠状动脉旁路移植术（CABG）的无保护 LMCA 疾病患者的长期预后信息有限。
我们评估了 2000 年至 2006 年间接受冠状动脉支架置入术（n=1102；裸金属支架 318 例，药物洗脱支架 784 例）或 CABG（n=1138）治疗且至少有 3 至 9 年（中位 5.2 年）完整随访数据的 2240 例无保护 LMCA 疾病患者。比较了使用逆概率治疗加权法和倾向评分匹配的 5 年不良结局（死亡；死亡、Q 波心肌梗死[MI]或卒中和靶血管血运重建[TVR]的复合结局）。
通过逆概率治疗加权调整基线风险因素差异后，支架置入组与 CABG 组相比，5 年死亡风险（风险比[HR]：1.13；95%置信区间[CI]：0.88 至 1.44，p=0.35）和死亡、Q 波 MI 或卒中的复合风险（HR：1.07；95%CI：0.84 至 1.37，p=0.59）差异无统计学意义。支架置入组 TVR 风险明显高于 CABG 组（HR：5.11；95%CI：3.52 至 7.42，p<0.001）。裸金属支架与同期 CABG 比较和药物洗脱支架与同期 CABG 比较的结果相似。在倾向评分匹配的进一步分析中，总体结果一致。
在 5 年随访期间，与 CABG 相比，无保护 LMCA 疾病患者支架置入组的死亡率和死亡、Q 波 MI 或卒中的复合结局发生率相似，但 TVR 发生率更高。
