Cho Yasunori, Misumi Takahiko, Shimura Shinichiro, Aki Akira, Furuya Hidekazu, Odagiri Shigeto, Okada Kimiaki, Ueda Toshihiko
Department of Cardiovascular Surgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Eur J Cardiothorac Surg. 2014 Mar;45(3):431-7. doi: 10.1093/ejcts/ezt429. Epub 2013 Aug 26.
We retrospectively analysed long-term outcomes after conventional coronary artery bypass grafting (CABG) between patients having left main (LM) disease who should have been assigned class II and those assigned class III recommendation for percutaneous coronary intervention (PCI) according to the 2010 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines.
From January 2000 to December 2009, conventional CABG was routinely employed in 180 consecutive patients with previously untreated and stable LM lesion. A comparison between two groups (CABG for PCI class II and CABG for PCI class III) was performed, looking at the primary endpoint of major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke [cerebral vascular accident (CVA)], myocardial infarction (MI) and repeat revascularization. We also analysed the effects of variables on MACCE at 8 years after the operation.
The overall 8-year MACCE rates were significantly lower in the CABG for PCI class II group than in the CABG for PCI class III group (9.7% class II vs 31.1% class III; P = 0.0005). This was largely because of an increased rate of repeat revascularization (1.2% class II vs 13.8% class III; P = 0.0029). The cumulative rate of the combined outcomes of all death/CVA/MI was significantly lower in the CABG for PCI class II group (8.5% class II vs 19.2% class III; P = 0.048); there was no observed difference between the groups for all-cause death, CVA and MI. The SYNTAX score was demonstrated to be the only significant predictor of combined outcomes (Death/CVA/MI) at 8 years [odds ratio (OR) 1.05, P = 0.023], repeat revascularization at 8 years (OR 1.11, P = 0.0013) and MACCE at 8 years (OR 1.07, P < 0.0001).
In our routine strategy of conventional CABG for LM disease, patients believed to be PCI candidates for LM disease have significantly better long-term outcomes as characterized by combined outcomes (Death/CVA/MI), repeat revascularization and MACCE. These results provide a suitable benchmark against which long-term outcomes of PCI for LM disease can be compared. The SYNTAX score, which was introduced to determine treatment for complex coronary disease, is indicative of long-term outcomes after CABG for LM disease.
我们回顾性分析了根据2010年欧洲心脏病学会和欧洲心胸外科学会指南，对于左主干（LM）疾病患者，本应被列为II类和那些被列为III类经皮冠状动脉介入治疗（PCI）推荐的患者，接受传统冠状动脉旁路移植术（CABG）后的长期结局。
从2000年1月至2009年12月，180例连续的既往未经治疗且病情稳定的LM病变患者常规接受了传统CABG。对两组（PCI II类推荐行CABG和PCI III类推荐行CABG）进行了比较，观察主要不良心脑血管事件（MACCE）的主要终点，包括全因死亡、卒中[脑血管意外（CVA）]、心肌梗死（MI）和再次血运重建。我们还分析了术后8年各变量对MACCE的影响。
PCI II类推荐行CABG组的总体8年MACCE发生率显著低于PCI III类推荐行CABG组（II类为9.7%，III类为31.1%；P = 0.0005）。这主要是由于再次血运重建率的增加（II类为1.2%，III类为13.8%；P = 0.0029）。PCI II类推荐行CABG组所有死亡/CVA/MI联合结局的累积发生率显著更低（II类为8.5%，III类为19.2%；P = 0.048）；两组在全因死亡、CVA和MI方面未观察到差异。SYNTAX评分被证明是8年联合结局（死亡/CVA/MI）[比值比（OR）1.05，P = 0.023]、8年再次血运重建（OR 1.11，P = 0.0013）和8年MACCE（OR 1.07，P < 0.0001）的唯一显著预测因素。
在我们针对LM疾病的传统CABG常规策略中，被认为是LM疾病PCI候选者的患者具有显著更好的长期结局，其特征为联合结局（死亡/CVA/MI）、再次血运重建和MACCE。这些结果提供了一个合适的基准，可据此比较LM疾病PCI的长期结局。用于确定复杂冠状动脉疾病治疗方案的SYNTAX评分，可指示LM疾病CABG后的长期结局。
