Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
JACC Cardiovasc Interv. 2020 Dec 28;13(24):2825-2836. doi: 10.1016/j.jcin.2020.08.021.
The aim of this study was to investigate the impact of lesion site (ostial or shaft vs. distal bifurcation) on long-term outcomes after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) disease.
Long-term comparative data after PCI and CABG for LMCA disease according to lesion site are limited.
Patients from the MAIN-COMPARE (Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty Versus Surgical Revascularization) registry were analyzed, comparing adverse outcomes (all-cause mortality [a composite outcome of death, Q-wave myocardial infarction, or stroke] and target vessel revascularization) between PCI and CABG according to LMCA lesion location during a median follow-up period of 12.0 years.
In overall population, the adjusted risks for death and serious composite outcome were higher after PCI than after CABG for distal bifurcation disease, which was mainly separated beyond 5 years. These outcomes were not different for ostial or shaft disease. When comparing drug-eluting stents (DES) and CABG, the adjusted risks for death and serious composite outcome progressively diverged beyond 5 years after DES compared with CABG for distal bifurcation disease (death: hazard ratio: 1.78; 95% confidence interval: 1.22 to 2.59; composite outcome: hazard ratio: 1.94; 95% confidence interval: 1.35 to 2.79). This difference was driven mainly by PCI with a 2-stent technique for distal bifurcation. In contrast, the adjusted risks for these outcomes were similar between DES and CABG for ostial or shaft disease.
Among patients with distal LMCA bifurcation disease, CABG showed lower mortality and serious composite outcome rates compared with DES beyond 5 years. However, there were no between-group differences in these outcomes among patients with ostial or shaft LMCA disease.
本研究旨在探讨左主干冠状动脉（LMCA）病变部位（开口或主干 vs. 远端分叉）对经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）后长期结局的影响。
根据病变部位对 LMCA 疾病 PCI 和 CABG 后长期比较数据有限。
对 MAIN-COMPARE（未保护的左主干冠状动脉狭窄的血运重建：经皮冠状动脉血管成形术与外科血运重建的比较）注册研究中的患者进行分析，比较中位随访 12.0 年后，根据 LMCA 病变位置，PCI 和 CABG 治疗的不良结局（全因死亡率[死亡、Q 波心肌梗死或卒中等复合结局]和靶血管血运重建）。
在总体人群中，与 CABG 相比，PCI 治疗远端分叉病变的死亡和严重复合结局风险更高，这种差异主要在 5 年后显现。对于开口或主干病变，这些结局没有差异。当比较药物洗脱支架（DES）和 CABG 时，与 CABG 相比，DES 治疗远端分叉病变的死亡和严重复合结局风险在 5 年后逐渐增加（死亡：风险比 1.78；95%置信区间 1.22 至 2.59；复合结局：风险比 1.94；95%置信区间 1.35 至 2.79）。这种差异主要是由远端分叉处采用 2 支架技术的 PCI 引起的。相比之下，DES 和 CABG 治疗开口或主干病变的这些结局风险相似。
在远端 LMCA 分叉病变患者中，CABG 与 DES 相比，5 年后死亡率和严重复合结局发生率较低。然而，在开口或主干 LMCA 病变患者中，两组之间这些结局没有差异。
