Park Sangwoo, Park Seung-Jung, Park Duk-Woo
Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
JACC Asia. 2022 Mar 15;2(2):119-138. doi: 10.1016/j.jacasi.2021.12.011. eCollection 2022 Apr.
For several decades, coronary artery bypass grafting has been regarded as the standard choice of revascularization for significant left main coronary artery (LMCA) disease. However, in conjunction with remarkable advancement of device technology and adjunctive pharmacology, percutaneous coronary intervention (PCI) offers a more expeditious approach with rapid recovery and is a safe and effective alternative in appropriately selected patients with LMCA disease. Several landmark randomized clinical trials showed that PCI with drug-eluting stents for LMCA disease is a safe option with similar long-term survival rates to coronary artery bypass grafting surgery, especially in those with low and intermediate anatomic risk. Although it is expected that the updated evidence from recent randomized clinical trials will determine the next guidelines for the foreseeable future, there are still unresolved and unmet issues of LMCA revascularization and PCI strategy. This paper provides a comprehensive review on the evolution and an update on the management of LMCA disease.
几十年来，冠状动脉旁路移植术一直被视为严重左主干冠状动脉（LMCA）疾病血运重建的标准选择。然而，随着设备技术和辅助药理学的显著进步，经皮冠状动脉介入治疗（PCI）提供了一种恢复更快的更迅速的方法，并且对于适当选择的LMCA疾病患者而言是一种安全有效的替代方案。几项具有里程碑意义的随机临床试验表明，采用药物洗脱支架治疗LMCA疾病的PCI是一种安全的选择，其长期生存率与冠状动脉旁路移植手术相似，尤其是在解剖风险较低和中等的患者中。尽管预计近期随机临床试验的最新证据将决定可预见未来的下一套指南，但LMCA血运重建和PCI策略仍存在未解决和未满足的问题。本文对LMCA疾病的演变及管理进展进行了全面综述。
