Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, 73 Eccles St, Dublin D07 KWR1, Ireland.
School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, D02 YN77 Dublin, Ireland.
Eur Heart J. 2023 Nov 1;44(41):4310-4320. doi: 10.1093/eurheartj/ehad476.
In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.
2021 年 10 月，欧洲心脏病学会（ESC）和欧洲心胸外科学会（EACTS）共同商定成立一个工作组（TF），审查 2018 年 ESC/EACTS 心肌血运重建指南中适用于低至中 SYNTAX 评分（0-32）的左主干（LM）疾病患者的建议。此前，EACTS 于 2019 年撤回了对前一指南中 LM 疾病管理建议的支持。TF 被要求审查自 2018 年指南以来的所有新的相关数据，包括比较经皮冠状动脉介入治疗（PCI）与药物洗脱支架与冠状动脉旁路移植术（CABG）治疗 LM 疾病的四项随机试验的更新汇总数据。本文件代表 TF 工作的总结；包括对接受 LM 疾病心肌血运重建患者的血运重建方式选择的建议更新建议。在有 LM 疾病血运重建指征且冠状动脉解剖适合两种手术且预测手术死亡率低的稳定患者中，TF 得出结论，基于患者偏好、现有专业知识和当地操作人员数量，两种治疗选择在临床上都是合理的。建议 CABG 血运重建的推荐为 I 类，证据水平为 A。PCI 的建议为 IIa 类，证据水平为 A。TF 认识到与 LM 疾病患者血运重建相关的几个重要知识差距，并认识到四项随机试验的汇总数据仍然仅足以排除死亡率的巨大差异。
