Cardiovascular Department, Ferrarotto Hospital, University of Catania, Italy.
Am J Cardiol. 2011 Aug 1;108(3):355-9. doi: 10.1016/j.amjcard.2011.03.050. Epub 2011 May 3.
Uncertainty surrounds the optimal revascularization strategy for patients with left main coronary artery disease presenting with acute coronary syndromes (ACSs), and adequately sized specific comparisons of percutaneous and surgical revascularization in this scenario are lacking. The aim of this study was to evaluate the incidence of 1-year major adverse cardiac events (MACEs) in patients with left main coronary artery disease and ACS treated with percutaneous coronary intervention (PCI) and drug-eluting stent implantation or coronary artery bypass grafting (CABG). A total of 583 patients were included. At 1 year, MACEs were significantly higher in patients treated with PCI (n = 222) compared to those treated with CABG (n = 361, 14.4% vs 5.3%, p <0.001), driven by a higher rate of target lesion revascularization (8.1% vs 1.7%, p = 0.001). This finding was consistent after statistical adjustment for MACEs (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.2 to 5.9, p = 0.01) and target lesion revascularization (adjusted HR 8.0, 95% CI 2.2 to 28.7, p = 0.001). No statistically significant differences between PCI and CABG were noted for death (adjusted HR 1.1, 95% CI 0.4 to 3.0, p = 0.81) and myocardial infarction (adjusted HR 4.8, 95% CI 0.3 to 68.6, p = 0.25). No interaction between clinical presentation (ST-segment elevation myocardial infarction or unstable angina/non-ST-segment elevation myocardial infarction) and treatment (PCI or CABG) was observed (p for interaction = 0.68). In conclusion, in patients with left main coronary artery disease and ACS, PCI is associated with similar safety compared to CABG but higher risk of MACEs driven by increased risk of repeat revascularization.
对于急性冠状动脉综合征（ACS）患者，左主干冠状动脉疾病的最佳血运重建策略尚不确定，并且缺乏该情况下经皮和外科血运重建的充分比较。本研究的目的是评估经皮冠状动脉介入治疗（PCI）和药物洗脱支架植入或冠状动脉旁路移植术（CABG）治疗的左主干冠状动脉疾病和 ACS 患者 1 年主要不良心脏事件（MACEs）的发生率。共纳入 583 例患者。1 年时，接受 PCI 治疗的患者（n=222）的 MACEs 明显高于接受 CABG 治疗的患者（n=361，14.4% vs 5.3%，p<0.001），这主要是由于靶病变血运重建的发生率较高（8.1% vs 1.7%，p=0.001）。这一发现经 MACEs（校正危险比[HR]2.7，95%置信区间[CI]1.2 至 5.9，p=0.01）和靶病变血运重建（校正 HR 8.0，95%CI 2.2 至 28.7，p=0.001）校正后仍然存在。在死亡（校正 HR 1.1，95%CI 0.4 至 3.0，p=0.81）和心肌梗死（校正 HR 4.8，95%CI 0.3 至 68.6，p=0.25）方面，PCI 与 CABG 之间无统计学差异。未观察到临床表型（ST 段抬高型心肌梗死或不稳定型心绞痛/非 ST 段抬高型心肌梗死）和治疗（PCI 或 CABG）之间的相互作用（p 交互=0.68）。总之，在左主干冠状动脉疾病和 ACS 患者中，与 CABG 相比，PCI 具有相似的安全性，但由于再次血运重建风险增加，MACEs 的风险更高。
