Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
Cardiol Rev. 2011 Jul-Aug;19(4):177-83. doi: 10.1097/CRD.0b013e318219244d.
Coronary artery disease with left main stenosis is associated with the highest mortality of any coronary lesion. Studies in the 1970s and 1980s comparing coronary artery bypass grafting (CABG) and medical therapy showed a significant survival benefit with revascularization. In the angioplasty era, initial experience with percutaneous intervention was associated with poor clinical outcomes. As a result, percutaneous coronary intervention (PCI) was restricted to patients who were considered inoperable, or those with prior CABG with a functional graft to the left anterior descending or circumflex artery ("protected left main disease"). With the introduction of drug-eluting stents, there are new studies demonstrating comparable survival in patients who were revascularized using PCI and CABG, although percutaneous revascularization is associated with a higher rate of repeat revascularization. In the SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) trial, the combined incidence of death, myocardial infarction, and stroke was similar between the CABG and PCI groups; however, the stroke rate was higher in the CABG group. The degree and extent of disease as defined by the SYNTAX scoring system has allowed for stratification of risk and improved assignment of patients with left main stenosis to either PCI or CABG.
左主干狭窄伴发的冠状动脉疾病与任何冠状动脉病变相比，死亡率最高。20 世纪 70 年代和 80 年代的研究比较了冠状动脉旁路移植术（CABG）和药物治疗，结果显示血运重建具有显著的生存获益。在经皮血管成形术时代，最初经皮介入治疗的经验与较差的临床结局相关。因此，经皮冠状动脉介入治疗（PCI）仅限于被认为不能手术的患者，或那些有功能的左前降支或回旋支旁路移植术（“保护左主干疾病”）的 CABG 患者。随着药物洗脱支架的引入，有新的研究表明，经 PCI 和 CABG 血运重建的患者的生存率相当，尽管经皮血运重建与更高的再次血运重建率相关。在 SYNTAX（PCI 与 Taxus 和心脏手术的协同作用）试验中，CABG 和 PCI 组的死亡、心肌梗死和卒中等复合终点发生率相似；然而，CABG 组的卒中转率更高。SYNTAX 评分系统定义的疾病程度和范围允许对风险进行分层，并改善了左主干狭窄患者的 PCI 或 CABG 分配。
