Columbia University Division of Cardiology at the Mount Sinai Medical Center, Miami Beach, Florida, USA.
Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.
Catheter Cardiovasc Interv. 2021 Jul 1;98(1):24-32. doi: 10.1002/ccd.29116. Epub 2020 Jun 27.
We examined outcomes according to lesion preparation strategy (LPS) in patients with left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the EXCEL trial.
The optimal LPS for LMCA PCI is unclear.
We categorized LPS hierarchically (high to low) as: (a) rotational atherectomy (RA); (b) cutting or scoring balloon (CSB); (c) balloon angioplasty (BAL); and d) direct stenting (DIR). The primary endpoint was 3-year MACE; all-cause death, stroke, or myocardial infarction.
Among 938 patients undergoing LMCA PCI, RA was performed in 6.0%, CSB 9.5%, BAL 71.3%, and DIR 13.2%. In patients treated with DIR, BAL, CSB, and RA, respectively, there was a progressive increase in SYNTAX score, LMCA complex bifurcation, trifurcation or calcification, number of stents, and total stent length. Any procedural complication occurred in 10.4% of cases overall, with the lowest rate in the DIR (7.4%) and highest in the RA group (16.1%) (p = .22). There were no significant differences in the 3-year rates of MACE (from RA to DIR: 17.9%, 20.2%, 14.5%, 14.7%; p = .50) or ischemia-driven revascularization (from RA to DIR: 16.8%, 10.8%, 12.3%, 14.2%; p = .65). The adjusted 3-year rates of MACE did not differ according to LPS.
The comparable 3-year outcomes suggest that appropriate lesion preparation may be able to overcome the increased risks of complex LMCA lesion morphology.
我们在 EXCEL 试验中检查了左主干冠状动脉（LMCA）经皮冠状动脉介入治疗（PCI）中根据病变准备策略（LPS）的结果。
LMCA PCI 的最佳 LPS 尚不清楚。
我们分层（从高到低）对 LPS 进行分类：（a）旋磨术（RA）；（b）切割或切割球囊（CSB）；（c）球囊血管成形术（BAL）；和（d）直接支架置入术（DIR）。主要终点是 3 年 MACE；全因死亡、卒中和心肌梗死。
在 938 例接受 LMCA PCI 的患者中，RA 占 6.0%，CSB 占 9.5%，BAL 占 71.3%，DIR 占 13.2%。在接受 DIR、BAL、CSB 和 RA 治疗的患者中，SYNTAX 评分、LMCA 复杂分叉、三叉或钙化、支架数量和总支架长度均逐渐增加。总体上任何手术并发症发生率为 10.4%，其中 DIR 组发生率最低（7.4%），RA 组发生率最高（16.1%）（p = .22）。3 年 MACE 发生率无显著差异（从 RA 到 DIR：17.9%、20.2%、14.5%、14.7%；p = .50）或缺血驱动血运重建（从 RA 到 DIR：16.8%、10.8%、12.3%、14.2%；p = .65）。LPS 对调整后的 3 年 MACE 发生率没有影响。
可比的 3 年结果表明，适当的病变准备可能能够克服复杂 LMCA 病变形态增加的风险。
