Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Catheter Cardiovasc Interv. 2019 Sep 1;94(3):315-322. doi: 10.1002/ccd.28119. Epub 2019 Feb 5.
Little is known about how the relative treatment effect of percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) on clinical outcomes in ostial or shaft left main coronary artery (LMCA) disease has evolved over time.
This study included 2,112 patients with ostial or shaft LMCA disease from IRIS-MAIN registry who underwent PCI (n = 1,329) or CABG (n = 783). Patients were stratified by time period based on stent type availability: wave 1 (1995-2002, bare-metal stent [BMS] era); wave 2 (2003-2006, first-generation drug-eluting stent [DES] era); and wave 3 (2007-2014, second-generation DES era).
Compared to CABG, PCI has been used more frequently from wave 1 to wave 3. PCI showed substantial improvements over time with respect to death (P for trend = 0.012); the composite of death, myocardial infarction (MI), or stroke (P for trend = 0.047); repeat revascularization (P for trend < 0.001); and major adverse cardiac and cerebrovascular events (MACCE; a composite of death, MI, stroke, or repeat revascularization) (P for trend < 0.001). By contrast, outcomes of CABG remained relatively stable over time. The gap between the treatment effects of CABG vs PCI for MACCE has narrowed over time; the adjusted hazard ratios for CABG compared to PCI during wave 1, 2, and 3 were 0.41 (95% confidence interval [CI]: 0.22-0.76), 0.47 (95% CI: 0.31-0.71), and 0.78 (95% CI: 0.50-1.20), respectively.
In patients with ostial or shaft LMCA disease, significant improvements in PCI outcomes resulted in a progressive decline in the gap between the outcomes of CABG and PCI.
关于经皮冠状动脉介入治疗（PCI）和冠状动脉旁路移植术（CABG）在开口或主干左主干冠状动脉（LMCA）疾病中的临床疗效的相对治疗效果随时间的变化知之甚少。
本研究纳入了来自 IRIS-MAIN 注册研究的 2112 例开口或主干 LMCA 疾病患者，其中 1329 例接受了 PCI，783 例接受了 CABG。根据支架类型的可用性，患者按时间分为 3 个时期：波 1（1995-2002 年，裸金属支架[BMS]时代）；波 2（2003-2006 年，第一代药物洗脱支架[DES]时代）；波 3（2007-2014 年，第二代 DES 时代）。
与 CABG 相比，PCI 的使用率从波 1 到波 3 逐渐增加。随着时间的推移，PCI 在死亡率（趋势 P=0.012）、死亡、心肌梗死（MI）或卒中（趋势 P=0.047）、再次血运重建（趋势 P<0.001）和主要心脏不良事件和脑血管事件（MACCE；死亡、MI、卒中或再次血运重建的复合终点）（趋势 P<0.001）方面取得了实质性的改善。相比之下，CABG 的治疗效果随时间相对稳定。CABG 与 PCI 治疗 MACCE 的效果差距随时间缩小；波 1、2 和 3 时 CABG 与 PCI 的调整后的危险比分别为 0.41（95%置信区间[CI]：0.22-0.76）、0.47（95% CI：0.31-0.71）和 0.78（95% CI：0.50-1.20）。
在开口或主干 LMCA 疾病患者中，PCI 结果的显著改善导致 CABG 和 PCI 治疗结果之间的差距逐渐缩小。
