López-Aguilar Carlos, Abundes-Velasco Arturo, Eid-Lidt Guering, Piña-Reyna Yigal, Gaspar-Hernández Jorge
Servicio de Angiografía, Hospital Eugenio Espejo, Av. Gran Colombia SN y Yaguachi, Quito, Ecuador.
Departamento de Cardiología Intervencionista, Instituto Nacional de Cardiología Dr. Ignacio Chávez, Juan Badiano N1, Sección XVI, del Tlalpan, C.P. 14080, Ciudad de México, México.
Arch Cardiol Mex. 2018 Apr-Jun;88(2):83-92. doi: 10.1016/j.acmx.2016.07.003. Epub 2016 Aug 21.
The best revascularisation method of the unprotected left main artery is a current and evolving topic.
A total of 2439 percutaneous coronary interventions (PCI) were registered during a 3-year period. The study included all the patients with PCI of the unprotected left main coronary (n=48) and matched with patients who underwent coronary artery bypass graft (CABG) (n=50). Major adverse cerebral and cardiac events (MACCE) were assessed within the hospital and in outpatients during a 16 month follow up.
The cardiovascular risk was greater in the PCI group; logEuroSCORE 16±21 vs. 5±6, P=.001; clinical Syntax 77±74 vs 53±39, P=.04. On admission, the PCI group of patients had a higher frequency of ST segment elevation myocardial infarction (STEMI) and cardiogenic shock. The MACCE were similar in both groups (14% vs. 18%, P=.64). STEMI was less frequent in the PCI group (0% vs. 10%, P=.03). Cardiovascular events were lower in the PCI group (2.3% vs. 18%, P=.01), and there was a decrease in general and cardiac mortality (2.3% vs. 12%, P=.08 y 2.3% vs. 8%, P=.24), on excluding the patients with cardiogenic shock as a presentation. MACCE were similar in both groups in the out-patient phase (15% vs. 12%, P=.46). Survival without MACCE, general and cardiac death were comparable between groups (log rank, P=.38, P=.44 and P=.16, respectively).
Even though the clinical and peri-procedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG.
无保护左主干动脉的最佳血运重建方法是当前一个不断发展的话题。
在3年期间共登记了2439例经皮冠状动脉介入治疗（PCI）。该研究纳入了所有接受无保护左主干冠状动脉PCI的患者（n = 48），并与接受冠状动脉旁路移植术（CABG）的患者（n = 50）进行匹配。在16个月的随访期间，对住院患者和门诊患者评估主要不良脑和心脏事件（MACCE）。
PCI组的心血管风险更高；欧洲心脏手术风险评估系统（EuroSCORE）log值为16±21 vs. 5±6，P = 0.001；临床SYNTAX评分77±74 vs 53±39，P = 0.04。入院时，PCI组患者ST段抬高型心肌梗死（STEMI）和心源性休克的发生率更高。两组的MACCE相似（14% vs. 18%，P = 0.64）。PCI组中STEMI的发生率较低（0% vs. 10%，P = 0.03）。排除以心源性休克为表现的患者后，PCI组的心血管事件较低（2.3% vs. 18%，P = 0.01），总体死亡率和心脏死亡率均有所下降（2.3% vs. 12%，P = 0.08；2.3% vs. 8%，P = 0.24）。门诊阶段两组的MACCE相似（15% vs. 12%，P = 0.46）。两组间无MACCE生存、总体死亡和心脏死亡情况相当（对数秩检验，P分别为0.38、0.44和0.16）。
尽管PCI患者的临床和围手术期风险特征较高，但其院内和院外疗效及安全性与CABG相当。
