Lee Pil Hyung, Ahn Jung-Min, Park Seung-Jung
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Expert Rev Cardiovasc Ther. 2015;13(8):933-43. doi: 10.1586/14779072.2015.1065730. Epub 2015 Jul 9.
Percutaneous coronary intervention (PCI) using drug-eluting stents (DES) is currently considered as a viable alternative to coronary artery bypass graft surgery (CABG) for selected patients with left main coronary artery disease. The updated results of the landmark randomized trials comparing CABG versus PCI demonstrated comparable 5-year outcomes and are in line with the current guidelines that designate PCI as a reasonable treatment in this disease subset. Given that the completed randomized trials did not include contemporary DESs, the upcoming results of the ongoing trials evaluating the performance of new-generation DES compared with CABG (such as the EXCEL trial), may further help to clarify the current role and future recommendations of PCI for left main coronary artery disease. Apart from the recent stent technology, further improvements in outcomes after PCI may be possible when it is used with an integrated approach that combines functional concepts for decision-making, adjunctive imaging support and optimal pharmacotherapies.
对于某些患有左主干冠状动脉疾病的患者，使用药物洗脱支架（DES）的经皮冠状动脉介入治疗（PCI）目前被认为是冠状动脉旁路移植术（CABG）的一种可行替代方案。比较CABG与PCI的具有里程碑意义的随机试验的最新结果显示，两者5年预后相当，符合当前将PCI指定为该疾病亚组合理治疗方法的指南。鉴于已完成的随机试验未纳入当代DES，正在进行的评估新一代DES与CABG相比性能的试验（如EXCEL试验）的即将公布的结果，可能会进一步有助于阐明PCI在左主干冠状动脉疾病中的当前作用和未来建议。除了近期的支架技术外，当PCI与结合了决策功能概念、辅助成像支持和最佳药物治疗的综合方法一起使用时，PCI术后的预后可能会进一步改善。
