Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Am J Cardiol. 2012 Oct 1;110(7):924-32. doi: 10.1016/j.amjcard.2012.05.022. Epub 2012 Jun 19.
The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the CABG group (22.7% vs 14.8%, p = 0.0006, log-rank test). However, the adjusted outcome was not different between the PCI and CABG groups (hazard ratio [HR] 1.30, 95% confidence interval [CI] 0.79 to 2.15, p = 0.30). Stratified analysis using the SYNTAX score demonstrated that risk for a composite of death/MI/stroke was not different between the 2 treatment groups in patients with low (<23) and intermediate (23 to 33) SYNTAX scores (adjusted HR 1.70, 95% CI 0.77 to 3.76, p = 0.19; adjusted HR 0.86, 95% CI 0.37 to 1.99, p = 0.72, respectively), whereas in patients with a high SYNTAX score (≥33), it was significantly higher after PCI than after CABG (adjusted HR 2.61, 95% CI 1.32 to 5.16, p = 0.006). In conclusion, risk of PCI for serious adverse events seemed to be comparable to that after CABG in patients with ULMCAD with a low or intermediate SYNTAX score, whereas PCI compared with CABG was associated with a higher risk for serious adverse events in patients with a high SYNTAX score.
经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗无保护左主干冠状动脉疾病（ULMCAD）的长期结果仍有待研究。我们在 CREDO-Kyoto PCI/CABG 注册队列-2 中纳入的 15939 例首次冠状动脉血运重建患者中，确定了 1005 例 ULMCAD 患者。PCI 组的 3 年复合死亡率/心肌梗死（MI）/卒中发生率显著高于 CABG 组（22.7% vs 14.8%，p=0.0006，对数秩检验）。然而，PCI 组与 CABG 组的调整后结局无差异（风险比[HR]1.30，95%置信区间[CI]0.79 至 2.15，p=0.30）。使用 SYNTAX 评分进行的分层分析表明，在低（<23）和中（23 至 33）SYNTAX 评分患者中，2 种治疗方法之间的死亡/MI/卒中复合风险无差异（调整 HR 1.70，95% CI 0.77 至 3.76，p=0.19；调整 HR 0.86，95% CI 0.37 至 1.99，p=0.72），而在高 SYNTAX 评分（≥33）患者中，PCI 后明显高于 CABG 后（调整 HR 2.61，95% CI 1.32 至 5.16，p=0.006）。总之，在低或中 SYNTAX 评分的 ULMCAD 患者中，PCI 治疗严重不良事件的风险似乎与 CABG 相当，而在高 SYNTAX 评分患者中，与 CABG 相比，PCI 与严重不良事件风险增加相关。
