Moore Peter, Burrage Matthew, Garrahy Paul, Lim Richard, McCann Andrew, Camuglia Anthony
Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia.
Department of Cardiology, Princess Alexandra Hospital, Brisbane, Qld, Australia; School of Medicine, University of Queensland, Brisbane, Qld, Australia.
Heart Lung Circ. 2018 Dec;27(12):1437-1445. doi: 10.1016/j.hlc.2017.09.008. Epub 2017 Oct 6.
Revascularisation of left main coronary artery (LMCA) disease can be potentially managed with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). Recent randomised controlled trial (RCT) data have added to the literature on this subject and this meta-analysis aims to assess the state of the data to assist in guiding patient treatment decisions.
A systematic literature search of Cochrane Library, EMBASE, OVID, and PubMed Medline was performed. Randomised controlled trials of patients with LMCA disease undergoing PCI with drug eluting stents or CABG were included. Clinical outcomes and adverse events were assessed and analysed.
Four suitable RCTs of adequate quality and follow-up were identified. The incidence of major adverse cardiac and cerebrovascular events (MACCE) at 3 to 5 years of follow-up was significantly increased with PCI compared to CABG (23.3% vs 18.2%, OR 1.37; 95% CI: 1.18-1.58; p=<0.0001; I=0%) and was largely driven by more repeat revascularisation procedures among patients treated with PCI. There was no statistically significant difference in rates of mortality, myocardial infarction or stroke (either individually or when these outcomes were combined as a composite endpoint).
Coronary artery bypass grafting and PCI both represent reasonable treatment modalities for LMCA disease in appropriately selected patients. However, where CABG is feasible it offers superior long-term freedom from repeat revascularisation. Longer-term follow-up is required to further clarify the durability of mortality outcomes, especially in patients treated with PCI.
左主干冠状动脉（LMCA）疾病的血运重建可通过经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）进行潜在管理。最近的随机对照试验（RCT）数据增加了关于该主题的文献，本荟萃分析旨在评估数据状况，以协助指导患者治疗决策。
对Cochrane图书馆、EMBASE、OVID和PubMed Medline进行系统的文献检索。纳入了接受药物洗脱支架PCI或CABG治疗的LMCA疾病患者的随机对照试验。对临床结局和不良事件进行评估和分析。
确定了四项质量和随访充分的合适RCT。与CABG相比，PCI术后3至5年随访时主要不良心脑血管事件（MACCE）的发生率显著增加（23.3%对18.2%，OR 1.37；95%CI：1.18 - 1.58；p =<0.0001；I = 0%），这主要是由接受PCI治疗的患者中更多的重复血运重建手术所致。死亡率、心肌梗死或中风发生率（单独或作为复合终点合并这些结局时）无统计学显著差异。
冠状动脉旁路移植术和PCI对于适当选择的LMCA疾病患者均代表合理的治疗方式。然而，在可行的情况下，CABG提供更好的长期免于重复血运重建的效果。需要更长时间的随访以进一步明确死亡率结局的持久性，尤其是在接受PCI治疗的患者中。
