Skorupski Wojciech Jan, Kałużna-Oleksy Marta, Lesiak Maciej, Araszkiewicz Aleksander, Skorupski Włodzimierz, Grajek Stefan, Mitkowski Przemysław, Pyda Małgorzata, Grygier Marek
1st Department of Cardiology, Poznań University of Medical Sciences, 61-848 Poznań, Poland.
J Pers Med. 2022 Feb 25;12(3):348. doi: 10.3390/jpm12030348.
The study aims to evaluate the short- and long-term outcomes of left main percutaneous coronary interventions (LM PCI) in patients disqualified from coronary artery bypass graft surgery (CABG). We included 459 patients (mean age: 68.4 ± 9.4 years, 24.4% females), with at least 1-year follow-up; 396 patients in whom PCI was offered as an alternative to CABG (Group 1); and 63 patients who were disqualified from CABG by the Heart Team (Group 2). The SYNTAX score (29.1 ± 9.5 vs. 23.2 ± 9.7; p < 0.001) and Euroscore II value (2.72 ± 2.01 vs. 2.15 ± 2.16; p = 0.007) were significantly higher and ejection fraction was significantly lower (46% vs. 51.4%; p < 0.001) in Group 2. Patients in Group 2 more often required complex stenting techniques (33.3% vs. 16.2%; p = 0.001). The procedure success rates were very high and did not differ between groups (100% vs. 99.2%; p = 0.882). We observed no difference in periprocedural complication rates (12.7% vs. 7.8%; p = 0.198), but the long-term all-cause mortality rate was higher in Group 2 (26% vs. 21%; p = 0.031). LM PCI in patients disqualified from CABG is an effective and safe procedure with a low in-hospital complication rate. Long-term results are satisfactory.
本研究旨在评估冠状动脉旁路移植术（CABG）禁忌患者行左主干经皮冠状动脉介入治疗（LM PCI）的短期和长期疗效。我们纳入了459例患者（平均年龄：68.4±9.4岁，女性占24.4%），随访时间至少1年；其中396例患者接受PCI作为CABG的替代方案（第1组）；63例患者被心脏团队判定为CABG禁忌（第2组）。第2组的SYNTAX评分（29.1±9.5 vs. 23.2±9.7；p<0.001）和欧洲心脏手术风险评估系统II值（2.72±2.01 vs. 2.15±2.16；p = 0.007）显著更高，射血分数显著更低（46% vs. 51.4%；p<0.001）。第2组患者更常需要复杂的支架置入技术（33.3% vs. 16.2%；p = 0.001）。手术成功率非常高，两组之间无差异（100% vs. 99.2%；p = 0.882）。我们观察到围手术期并发症发生率无差异（12.7% vs. 7.8%；p = 0.198），但第2组的长期全因死亡率更高（26% vs. 21%；p = 0.031）。CABG禁忌患者行LM PCI是一种有效且安全的手术，院内并发症发生率低。长期结果令人满意。
