Park Seung-Jung, Kim Young-Hak
Seung-Jung Park, Young-Hak Kim, Cardiac Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, South Korea.
World J Cardiol. 2010 Apr 26;2(4):78-88. doi: 10.4330/wjc.v2.i4.78.
Hemodynamically significant left main coronary artery stenosis (LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery has no previous patent grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization by coronary artery bypass graft (CABG) surgery was undertaken compared with medical treatment. Therefore, current practice guidelines do not recommend percutaneous coronary intervention (PCI) for such a lesion because of the proven benefit of surgery and high rates of restenosis with the use of bare metal stents. However, with the advent of drug-eluting stents (DES), the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable. Therefore, apart from the current guidelines, PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy. Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.
在约4%的诊断性冠状动脉造影中可发现具有血流动力学意义的左主干冠状动脉狭窄（LMCA），如果左冠状动脉和左旋支动脉此前没有开通的移植血管，则称为无保护的LMCA狭窄。既往随机研究表明，与药物治疗相比，采用冠状动脉旁路移植术（CABG）进行血运重建时死亡率显著降低。因此，由于手术已证实的益处以及使用裸金属支架时再狭窄率较高，当前的实践指南不推荐对这种病变进行经皮冠状动脉介入治疗（PCI）。然而，随着药物洗脱支架（DES）的出现，使用DES进行PCI治疗无保护LMCA狭窄的长期结果是可以接受的。因此，除了当前指南外，对于CABG风险极高或拒绝接受胸骨切开术的患者，常采用PCI治疗无保护LMCA狭窄。未来比较CABG与使用DES进行PCI治疗无保护LMCA狭窄的随机研究，将是临床知识在采用适当治疗方面的一大进步。
