Śmiech Karol, Brust Krzysztof, Bujak Kamil, Gąsior Mariusz, Roleder Tomasz
Regional Specialist Hospital, Research and Development Center, Wroclaw, Poland.
3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze Medical University of Silesia in Katowice, Poland.
Cardiol J. 2025;32(3):278-290. doi: 10.5603/cj.98087. Epub 2025 May 21.
The treatment of left main coronary artery disease (LMCAD) in acute coronary syndrome patients is challenging in daily clinical practice. Therefore, the question arises whether the clinical outcomes of acute coronary syndrome (ACS) patients with LM disease vary between centers with and without cardiac surgery on site.
The study is a retrospective analysis of ACS patient outcomes using data from the PL-ACS registry, which is a Polish archive of ACS patients. The following analysis considered patients with LMCAD (n=4000) who were divided into two groups: those treated in the centers with the cardiac surgery department on site (CS group, n=427) and those without (non-CS group, n=3573).
Patients with ACS in non-CS group more often were not qualified for revascularization than patients in CS group (11.7% in the CS group vs. 19.9% in the non-CS group, p<0.001), however, CABG was more common in non-CS group (18.7% in CS group vs. 25.7% in non-CS group, p<0.001). PCI, including angioplasty of LM, was more common in CS-group than non-CS group (38,6% vs. 30,3%, p<0.001). Among patients with ACS in CS group, major adverse cardiac events (MACE) were observed with greater frequency.
Patients with LM disease admitted to the centers with CS initially had more risk factors for more intensive hospitalization compared to patients in centers without CS on-site. Clinical outcomes and treatment procedures may differ regarding the availability of CS on-site.
在日常临床实践中,急性冠状动脉综合征患者左主干冠状动脉疾病(LMCAD)的治疗具有挑战性。因此,问题在于有心脏外科手术和没有心脏外科手术的中心,急性冠状动脉综合征(ACS)合并左主干病变患者的临床结局是否存在差异。
本研究是一项对ACS患者结局的回顾性分析,使用来自波兰ACS患者数据库PL-ACS登记处的数据。以下分析纳入了4000例LMCAD患者,分为两组:在有心脏外科的中心接受治疗的患者(CS组,n = 427)和没有心脏外科的中心的患者(非CS组,n = 3573)。
非CS组的ACS患者比CS组的患者更常不符合血运重建条件(CS组为11.7%,非CS组为19.9%,p<0.001),然而,冠状动脉旁路移植术(CABG)在非CS组更常见(CS组为18.7%,非CS组为25.7%,p<0.001)。包括左主干血管成形术在内的经皮冠状动脉介入治疗(PCI)在CS组比非CS组更常见(38.6%对30.3%,p<0.001)。在CS组的ACS患者中,主要不良心脏事件(MACE)的发生率更高。
与没有心脏外科的中心的患者相比,入住有心脏外科的中心的左主干病变患者最初有更多危险因素,需要更强化的住院治疗。临床结局和治疗程序可能因是否有心脏外科而有所不同。