Medical Sciences Departement, Cardiology Unit, ASST Bergamo Est, Bolognini Hospital, Seriate, Bergamo, Italy.
Division of Interventional Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy.
J Interv Cardiol. 2022 Apr 12;2022:6496777. doi: 10.1155/2022/6496777. eCollection 2022.
This study is aimed at comparing the clinical outcomes of unprotected left main coronary artery disease (ULMCAD) treatment with contemporary percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a "real-world" population.
Overall, 558 consecutive patients with ULMCAD (mean age 71 ± 9 years, male gender 81%) undergoing PCI or CABG were compared. The primary endpoint was the composite of death, nonfatal myocardial infarction, or stroke. Diabetes was present in 29% and acute coronary syndrome in 56%; mean EuroSCORE was 11 ± 8. High coronary complexity (SYNTAX score >32) was present in 50% of patients. The primary composite endpoint was similar after PCI and CABG up to 4 years (15.5 ± 3.1% vs. 17.1 ± 2.6%; =0.585). The primary end point was also comparable in a two propensity score matched cohorts. Ischemia-driven revascularization was more frequently needed in PCI than in CABG (5.5% vs. 1.5%; =0.010). By multivariate analysis, diabetes mellitus (HR 2.00; =0.003) and EuroSCORE (HR 3.71; < 0.001) were the only independent predictors associated with long-term outcome.
In a "real-world" population with ULMCAD, a contemporary revascularization strategy by PCI or CABG showed similar long-term clinical outcome regardless of the coronary complexity.
本研究旨在比较无保护左主干冠状动脉疾病（ULMCAD）经当代经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）治疗的临床结局，并在“真实世界”人群中进行比较。
共比较了 558 例连续接受 PCI 或 CABG 治疗的 ULMCAD 患者（平均年龄 71±9 岁，男性 81%）。主要终点是死亡、非致死性心肌梗死或卒中的复合终点。29%的患者合并糖尿病，56%的患者为急性冠状动脉综合征；平均 EuroSCORE 为 11±8。50%的患者存在高冠状动脉复杂性（SYNTAX 评分>32）。PCI 和 CABG 后 4 年内主要复合终点相似（15.5±3.1%比 17.1±2.6%；=0.585）。在两个倾向评分匹配队列中，主要终点也相似。PCI 组缺血驱动的血运重建更为频繁（5.5%比 1.5%；=0.010）。多变量分析显示，糖尿病（HR 2.00；=0.003）和 EuroSCORE（HR 3.71；<0.001）是与长期预后相关的唯一独立预测因素。
在 ULMCAD 的“真实世界”人群中，PCI 或 CABG 的当代血运重建策略无论冠状动脉复杂程度如何，均显示出相似的长期临床结局。
