Panagiotopoulos Ioannis, Mulita Francesk, Verras Georgios-Ioannis, Bekou Eleni, Mulita Admir, Dahm Manfred, Grapatsas Konstantinos, Sawafta Assaf, Katinioti Anastasia, Liolis Elias, Pitros Christos, Tchabashvili Levan, Tasios Konstantinos, Antzoulas Andreas, Papadoulas Spyros, Koletsis Efstratios, Leivaditis Vasileios
Department of Cardiothoracic Surgery, General University Hospital of Patras, Patras, Greece.
Department of Surgery, General University Hospital of Patras, Patras, Greece.
Kardiochir Torakochirurgia Pol. 2024 Jun;21(2):108-112. doi: 10.5114/kitp.2024.141149. Epub 2024 Jun 30.
Significant unprotected left main (ULM) disease is the highest-risk coronary artery lesion, carries high morbidity and mortality related to a large amount of myocardium supplied, and should undergo prompt revascularization. Among recent randomized controlled trials (RCTs), NOBLE failed to demonstrate non-inferiority of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). However, all the other RCTs have shown comparable outcomes. While CABG is associated with higher stroke rates at 30 days and 1 year, PCI is associated with increased spontaneous myocardial infarction (MI) events and the need for repeat revascularization. Furthermore, the benefit of CABG is more evident with the increased complexity of coronary artery disease. In current European and American guidelines, CABG is the standard of care for ULM disease. PCI is considered a reasonable alternative in selected patients (2a B-NR). There is still a great need for carefully designed RCTs with longer follow-up times to validate the role of recent technological and pharmacological regimens.
严重的无保护左主干（ULM）病变是风险最高的冠状动脉病变，因其供血的心肌量巨大，具有较高的发病率和死亡率，应立即进行血运重建。在最近的随机对照试验（RCT）中，NOBLE试验未能证明经皮冠状动脉介入治疗（PCI）不劣于冠状动脉旁路移植术（CABG）。然而，所有其他RCT均显示了可比的结果。虽然CABG在30天和1年时与较高的卒中发生率相关，但PCI与自发性心肌梗死（MI）事件增加及再次血运重建需求相关。此外，随着冠状动脉疾病复杂性增加，CABG的益处更为明显。在当前欧美指南中，CABG是ULM病变的标准治疗方法。PCI被认为是部分选定患者（2a B-NR）的合理替代方案。仍迫切需要设计更完善、随访时间更长的RCT，以验证近期技术和药物治疗方案的作用。
