Piedmont Heart Institute, Atlanta, GA 30309, USA.
Curr Cardiol Rep. 2011 Oct;13(5):424-31. doi: 10.1007/s11886-011-0196-z.
Coronary artery bypass grafting (CABG) has been considered the standard therapy for unprotected (nonrevascularized) left main coronary disease (ULM). However, increasing experience with ULM percutaneous coronary intervention (PCI) has resulted in high procedural success and favorable early and late clinical outcomes. In particular, reduction in clinical restenosis with drug-eluting stents, evolution of procedural technique, and demonstration of favorable outcomes from comparative trials with CABG have promoted consideration of PCI as an alternative revascularization strategy in selected patients with ULM disease. This review summarizes the results from comparative studies examining PCI versus CABG for ULM disease, discusses changing indications for ULM PCI and identifies outstanding issues that must be considered before further advancing treatment recommendations.
冠状动脉旁路移植术（CABG）一直被认为是治疗无保护（未血运重建）左主干冠状动脉疾病（ULM）的标准疗法。然而，随着经皮冠状动脉介入治疗（PCI）在 ULM 中的应用经验不断增加，其手术成功率高，且早期和晚期临床结果良好。特别是药物洗脱支架减少了临床再狭窄，手术技术的发展，以及与 CABG 进行的比较试验的良好结果，促使人们考虑将 PCI 作为 ULM 疾病患者的一种替代血运重建策略。本文综述了比较 PCI 与 CABG 治疗 ULM 疾病的研究结果，讨论了 ULM PCI 的适应证变化，并确定了在进一步提出治疗建议之前需要考虑的未决问题。
