Department of Cardiology, Dong-A University Hospital, 32 Daesingongwon-ro, Seo-gu, Busan, Republic of Korea, 602-714.
J Invasive Cardiol. 2020 Mar;32(3):111-116. doi: 10.25270/jic/19.00292. Epub 2020 Jan 15.
We compared the long-term outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) disease in a real-world population.
CABG is the standard of care for ULMCA disease. Contemporary randomized trials have reported conflicting results with the two revascularization strategies for the treatment of ULMCA disease at intermediate-term follow-up.
We evaluated 422 consecutive patients with ULMCA disease who underwent CABG (n = 273) or PCI (n = 149) from 1998-2008. The primary outcome measure was major adverse cardiac and cerebrovascular event (MACCE) rate, defined as the composite of all-cause death, myocardial infarction (MI), stroke, or target-vessel revascularization (TVR) at 10 years. Propensity-score matched (PSM) analysis was used to assess long-term MACCE.
The cumulative 10-year incidence of risk for MACCE was not significantly different between the PCI and CABG groups (24.8% vs 20.5%, respectively; log rank P=.22; log rank PSM P=.45). The risk for all-cause death was not significantly different between the two groups (log rank P=.09; PSM log rank P=.51). The risk for stroke was significantly lower with PCI (log rank P=.02), but was not significant after matching (PSM log rank P=.27). The risk for TVR was significantly higher with PCI vs CABG prior to and after matching (log rank P<.001; log rank PSM P=.01). There were no significant differences in MACCE between the two groups when stratified by SYNTAX scores ≤22% (log rank P=.61) and >23% (log rank P=.06).
In patients with ULMCA disease, PCI was comparable with CABG for long-term MACCE and death rates. The TVR rate was higher in the PCI group.
我们比较了在真实世界人群中，经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）治疗无保护左主干冠状动脉（ULMCA）疾病的长期结局。
CABG 是 ULMCA 疾病的标准治疗方法。当代随机试验报告称，在中期随访时，两种血运重建策略治疗 ULMCA 疾病的结果存在矛盾。
我们评估了 1998 年至 2008 年间接受 CABG（n=273）或 PCI（n=149）治疗的 422 例 ULMCA 疾病连续患者。主要观察终点为主要不良心脑血管事件（MACCE）发生率，定义为全因死亡、心肌梗死（MI）、卒中和靶血管血运重建（TVR）的复合终点，随访时间为 10 年。采用倾向评分匹配（PSM）分析评估长期 MACCE。
PCI 组和 CABG 组 10 年累积 MACCE 发生率无显著差异（分别为 24.8%和 20.5%，对数秩 P=0.22；对数秩 PSM P=0.45）。两组间全因死亡风险无显著差异（对数秩 P=0.09；PSM 对数秩 P=0.51）。PCI 组的卒中风险较低（对数秩 P=0.02），但匹配后无统计学意义（PSM 对数秩 P=0.27）。PCI 组与 CABG 组在匹配前后的 TVR 风险均较高（对数秩 P<0.001；对数秩 PSM P=0.01）。按 SYNTAX 评分≤22%（对数秩 P=0.61）和>23%（对数秩 P=0.06）分层后，两组间 MACCE 无显著差异。
在 ULMCA 疾病患者中，PCI 与 CABG 的长期 MACCE 和死亡率相当。PCI 组的 TVR 发生率较高。
