无保护左主干病变经药物洗脱支架或冠状动脉旁路移植术治疗患者的动脉粥样硬化性冠状动脉疾病的复杂性及长期结局。

Complexity of atherosclerotic coronary artery disease and long-term outcomes in patients with unprotected left main disease treated with drug-eluting stents or coronary artery bypass grafting.

机构信息

Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

出版信息

J Am Coll Cardiol. 2011 May 24;57(21):2152-9. doi: 10.1016/j.jacc.2011.01.033.

DOI:10.1016/j.jacc.2011.01.033

PMID:21596230

Abstract

OBJECTIVES

The aim of this study was to compare treatment effects of drug-eluting stents (DES) or coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease according to the complexity of atherosclerotic disease burden.

BACKGROUND

Limited information is available on the relationships between the extent of coronary atherosclerosis and very long-term outcomes of surgical or percutaneous LMCA revascularization.

METHODS

A total of 1,146 patients with unprotected LMCA disease who received DES (n = 645) or underwent CABG (n = 501) were evaluated. The extent of atherosclerotic disease burden was measured using the SYNTAX (Synergy Between PCI With Taxus and Cardiac Surgery) score; a low-risk score was defined as ≤ 22, an intermediate-risk score as 23 to 32, and a high-risk score as ≥ 33.

RESULTS

After multivariate adjustment with the inverse-probability-of-treatment weighting method, the 5-year risks for death (6.1% for DES vs. 16.2% for CABG; hazard ratio [HR]: 0.52; 95% confidence interval [CI]: 0.21 to 1.28; p = 0.15) and the composite of death, Q-wave myocardial infarction, or stroke (6.4% vs. 16.2%; HR: 0.54; 95% CI: 0.22 to 1.34; p = 0.18) favored DES in patients with low-risk SYNTAX scores; in contrast, the 5-year risks for death (26.9% vs. 17.8%; HR: 1.46; 95% CI: 0.92 to 2.30; p = 0.11) and the composite outcome (27.6% vs. 19.5%; HR: 1.36; 95% CI: 0.87 to 2.12; p = 0.18) favored CABG in patients with high-risk SYNTAX scores (interaction p = 0.047 for death, interaction p = 0.08 for composite outcome). Patients undergoing CABG consistently had lower rates of target vessel revascularization.

CONCLUSIONS

According to the complexity of concomitant coronary disease, there were differential treatment effects on long-term mortality in patients with unprotected LMCA disease who received DES or underwent CABG.

摘要

目的

本研究旨在根据动脉粥样硬化病变负担的复杂程度比较药物洗脱支架（DES）和冠状动脉旁路移植术（CABG）治疗左主干冠状动脉（LMCA）疾病的效果。

背景

关于经皮或外科 LMCA 血运重建的非常长期结果与冠状动脉粥样硬化严重程度之间的关系，目前仅有有限的信息。

方法

共评估了 1146 例接受 DES（n = 645）或 CABG（n = 501）治疗的无保护 LMCA 疾病患者。使用 SYNTAX（紫杉醇与心脏手术联合的协同作用）评分评估动脉粥样硬化病变负担的程度；低危评分定义为≤22，中危评分定义为 23 至 32，高危评分定义为≥33。

结果

经逆概率治疗加权法多变量校正后，DES 组 5 年死亡风险（6.1% vs. CABG 组 16.2%；风险比[HR]：0.52；95%置信区间[CI]：0.21 至 1.28；p = 0.15）和死亡、Q 波心肌梗死或卒中的复合终点（6.4% vs. CABG 组 16.2%；HR：0.54；95% CI：0.22 至 1.34；p = 0.18）在低危 SYNTAX 评分患者中更有利于 DES；相比之下，高危 SYNTAX 评分患者的 5 年死亡风险（26.9% vs. CABG 组 17.8%；HR：1.46；95% CI：0.92 至 2.30；p = 0.11）和复合终点（27.6% vs. CABG 组 19.5%；HR：1.36；95% CI：0.87 至 2.12；p = 0.18）更有利于 CABG（死亡的交互作用 p = 0.047，复合终点的交互作用 p = 0.08）。行 CABG 的患者靶血管血运重建率始终较低。