Morehouse School of Medicine, Atlanta, GA, USA.
Ochsner Medical Center, New Orleans, LA, USA.
Curr Cardiol Rep. 2019 Mar 18;21(5):27. doi: 10.1007/s11886-019-1113-0.
This article reviews the latest data on unprotected left main (ULM) percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) surgery, with a focus on the NOBLE and EXCEL trials.
In EXCEL trial, the primary endpoint at 3 years was 15.4% in the PCI group and 14.7% in the CABG group (p = 0.02 for non-inferiority of PCI versus CABG). In NOBLE, the primary endpoint at 5 years was 28% and 18% for PCI and CABG, respectively (HR 1.51, CI 1.13-2.0, which did not meet the criteria for non-inferiority of PCI to CABG; p for superiority of CABG was 0.0044). Higher repeat revascularization and non-procedural myocardial infarction were noted in PCI group but there was no difference in all-cause or cardiac mortality between the two groups. A heart team approach with appropriate patient selection, careful assessment of LM lesions, and meticulous procedural technique makes PCI a valid alternative to CABG for ULM stenosis.
本文回顾了最新的非保护左主干（ULM）经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）的研究数据，重点关注 NOBLE 和 EXCEL 试验。
EXCEL 试验中，PCI 组的 3 年主要终点为 15.4%，CABG 组为 14.7%（PCI 与 CABG 相比非劣效性的 P 值为 0.02）。NOBLE 试验中，PCI 和 CABG 组的 5 年主要终点分别为 28%和 18%（HR 1.51，CI 1.13-2.0，未达到 PCI 非劣效于 CABG 的标准；CABG 组的优越性 P 值为 0.0044）。PCI 组重复血运重建和非手术性心肌梗死的发生率更高，但两组之间全因或心脏死亡率无差异。心脏团队采用适当的患者选择、仔细评估 LM 病变和精细的手术技术，使 PCI 成为 ULM 狭窄的 CABG 有效替代方法。
