El-Andari Ryaan, Kang Jimmy, Fialka Nicholas, Hong Yongzhe, McAlister Finlay A, Nagendran Jeevan, Nagendran Jayan
Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Commun Med (Lond). 2025 Sep 29;5(1):402. doi: 10.1038/s43856-025-01098-w.
Coronary artery bypass grafting(CABG) has long been the preferred treatment for left main coronary artery disease(LMCAD), although percutaneous coronary intervention(PCI) has been increasingly utilized. Despite numerous investigations seeking to identify the optimal revascularization strategy for LMCAD, limitations in sample size or follow-up duration have hindered definitive conclusions. Herein, we compare the long-term outcomes up to 14 years after CABG or PCI for patients with LMCAD.
Data was retrospectively collected from a provincial database. The inclusion criteria is patients ≥18 years old, with LMCAD, and revascularization with CABG or PCI. The primary outcome is all-cause mortality. Secondary outcomes are any rehospitalization, myocardial infarction (MI), stroke, or repeat revascularization. Outcomes are adjusted for age, sex, and clinical comorbidities. The average age of the patients was 67 ± 9 years for the CABG patients and 71 ± 11 years for the PCI patients. 84.7% of the CABG patients and 71.5% of the PCI patients were male.
5580 patients are identified with LMCAD between 2009 and 2018. 1706 patients (1180 CABG; 526 PCI) are included in the final analysis and followed until March 31, 2023. Rates of mortality at longest follow-up of 14 years are 40.0% for CABG and 58.4% for PCI (adjusted hazard ratio(aHR) 0.58, 95% confidence interval(CI) 0.48-0.70, p < 0.001). Rates of MI (10.7% vs 22.3%, aHR 0.40, 95% CI 0.29-0.55, p < 0.001) and repeat revascularization (5.4%vs16.3%, aHR 0.25, 95% CI 0.18-0.36, p < 0.001) favor CABG over PCI.
Patients with LMCAD undergoing CABG experience significant benefit over PCI in terms of long-term mortality, MI, and required repeat revascularization. These finding suggest CABG should remain the preferred revascularization strategy for patients with LMCAD and acceptable surgical risk. Future studies should explore evolving PCI techniques and their impact on long-term outcomes.
冠状动脉旁路移植术（CABG）长期以来一直是左主干冠状动脉疾病（LMCAD）的首选治疗方法，尽管经皮冠状动脉介入治疗（PCI）的应用越来越广泛。尽管有许多研究试图确定LMCAD的最佳血运重建策略，但样本量或随访时间的限制阻碍了得出明确结论。在此，我们比较了LMCAD患者接受CABG或PCI后长达14年的长期结局。
数据从省级数据库中回顾性收集。纳入标准为年龄≥18岁、患有LMCAD且接受CABG或PCI血运重建的患者。主要结局是全因死亡率。次要结局是任何再次住院、心肌梗死（MI）、中风或再次血运重建。结局根据年龄、性别和临床合并症进行调整。CABG组患者的平均年龄为67±9岁，PCI组患者的平均年龄为71±11岁。CABG组患者中84.7%为男性，PCI组患者中71.5%为男性。
2009年至2018年期间，共识别出5580例LMCAD患者。最终分析纳入了1706例患者（1180例CABG；526例PCI），并随访至2023年3月31日。在最长14年的随访中，CABG组的死亡率为40.0%，PCI组为58.4%（调整后风险比[aHR]为0.58，95%置信区间[CI]为0.48-0.70，p<0.001）。MI发生率（10.7%对22.3%，aHR为0.40，95%CI为0.29-0.55，p<0.001）和再次血运重建率（5.4%对16.3%，aHR为0.25，95%CI为0.18-0.36，p<0.001）显示CABG优于PCI。
接受CABG的LMCAD患者在长期死亡率、MI和再次血运重建需求方面比接受PCI的患者有显著益处。这些发现表明，对于具有可接受手术风险的LMCAD患者，CABG应仍然是首选的血运重建策略。未来的研究应探索不断发展的PCI技术及其对长期结局的影响。
