微创冠状动脉旁路移植术与经皮冠状动脉介入治疗左主干病变的长期疗效比较。

Comparison of long-term outcomes of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention for left main disease.

作者信息

Güner Ahmet, Can Cemil, Bedir Fatih Furkan, Aydin Ünal, Kadiroğullari Ersin, Akman Cemalettin, Gültekin Güner Ezgi, Aydin Emre, Serter Berkay, Çizgici Ahmet Yaşar, Aktürk İbrahim Faruk, İyigün Taner, Aksu Timuçin, Doğan Abdullah, Aydin Merve, Şimşek Aybüke, Uzun Fatih

机构信息

Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital.

Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

出版信息

Coron Artery Dis. 2025 Aug 1;36(5):406-415. doi: 10.1097/MCA.0000000000001504. Epub 2025 Jan 17.

DOI:10.1097/MCA.0000000000001504

PMID:39836499

Abstract

BACKGROUND

Minimally invasive coronary artery bypass grafting (MICS-CABG) is frequently used for coronary revascularization, but the comparison of long-term clinical results with percutaneous coronary intervention (PCI) in left main disease (LMDs) remains unclear. The present study sought to determine the long-term outcomes of MICS-CABG and PCI in patients with LMDs.

METHODS

A total of 551 consecutive patients [man: 457 (82.9%), mean age: 60.70 ± 9.54 years] who underwent PCI or MICS-CABG for LMDs were included. The primary endpoint was defined as the all-cause death during follow-up. The secondary endpoint defined as the major cardiovascular and cerebral events (MACCE) included cardiac death, myocardial infarction, target vessel revascularization, stroke, and stent thrombosis or graft occlusion. Inverse probability weighting (IPW) was performed to reduce treatment selection bias. This is the first report comparing the long-term outcomes of MICS-CABG and PCI in patients with LMDs.

RESULTS

The initial revascularization strategy was MICS-CABG in 269 (48.8%) cases and PCI in 282 (51.2%) patients. The SYNTAX scores (31.25 ± 4.63 vs. 26.05 ± 5.9, P < 0.001) were notably higher in the MICS-CABG group than in the PCI group. The incidence of long-term mortality (11 vs. 5.6%, P = 0.022) and MACCE (22 vs. 15.2%, P = 0.042) were notably higher in the PCI group than in the MICS-CABG group. The long-term mortality [adjusted HR (IPW) = 6.38 (95% CI, 3.00-13.57), P < 0.001] and MACCE [adjusted HR (IPW) = 4.51 (95% CI, 2.90-7.03), P < 0.001] in the overall population significantly differed between the PCI group and the MICS-CABG group.

CONCLUSION

The present study suggests that MICS-CABG for LMDs was associated with lower long-term mortality and MACCE rates than PCI.

摘要

背景

微创冠状动脉旁路移植术（MICS-CABG）常用于冠状动脉血运重建，但在左主干病变（LMDs）中，其与经皮冠状动脉介入治疗（PCI）的长期临床结果比较仍不明确。本研究旨在确定LMDs患者接受MICS-CABG和PCI的长期结局。

方法

纳入551例因LMDs接受PCI或MICS-CABG的连续患者[男性：457例（82.9%），平均年龄：60.70±9.54岁]。主要终点定义为随访期间的全因死亡。次要终点定义为主要心血管和脑血管事件（MACCE），包括心源性死亡、心肌梗死、靶血管血运重建、中风以及支架血栓形成或移植物闭塞。采用逆概率加权（IPW）以减少治疗选择偏倚。这是首篇比较LMDs患者MICS-CABG和PCI长期结局的报告。

结果

初始血运重建策略为MICS-CABG的有269例（48.8%），PCI的有282例（51.2%）。MICS-CABG组的SYNTAX评分（31.25±4.6·3对26.05±5.9，P<0.001）显著高于PCI组。PCI组的长期死亡率（11%对5.6%，P=0.022）和MACCE发生率（22%对15.2%，P=0.042）显著高于MICS-CABG组。PCI组和MICS-CABG组在总体人群中的长期死亡率[校正风险比（IPW）=6.38（95%CI，3.00-13.57），P<0.001]和MACCE[校正风险比（IPW）=4.51（95%CI，2.90-7.03），P<0.001]存在显著差异。