Left main coronary artery disease: percutaneous coronary intervention or coronary artery bypass grafting? A critical review of current knowledge and contemporary debates.

IF 0.6 Q4 SURGERY Kardiochirurgia I Torakochirurgia Polska Pub Date : 2024-06-01 Epub Date: 2024-06-30 DOI:10.5114/kitp.2024.141149
Ioannis Panagiotopoulos, Francesk Mulita, Georgios-Ioannis Verras, Eleni Bekou, Admir Mulita, Manfred Dahm, Konstantinos Grapatsas, Assaf Sawafta, Anastasia Katinioti, Elias Liolis, Christos Pitros, Levan Tchabashvili, Konstantinos Tasios, Andreas Antzoulas, Spyros Papadoulas, Efstratios Koletsis, Vasileios Leivaditis
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Abstract

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.

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左主干冠状动脉疾病:经皮冠状动脉介入治疗还是冠状动脉旁路移植术?对当前知识和当代争论的批判性回顾。
严重的无保护左主干(ULM)疾病是风险最高的冠状动脉病变,其发病率和死亡率与大量心肌供血有关,应立即进行血管重建。在近期的随机对照试验(RCT)中,NOBLE 未能证明经皮冠状动脉介入治疗(PCI)与冠状动脉旁路移植术(CABG)的非劣效性。然而,所有其他研究都显示出了相似的结果。CABG 在 30 天和 1 年后的中风率较高,而 PCI 则会增加自发性心肌梗死(MI)事件和重复血管再通的需要。此外,随着冠状动脉疾病复杂程度的增加,CABG 的益处也更加明显。在目前的欧美指南中,CABG 是治疗 ULM 疾病的标准方法。PCI 被认为是特定患者的合理选择(2a B-NR)。目前仍亟需进行精心设计、随访时间更长的 RCT 研究,以验证最新技术和药物疗法的作用。
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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Polish Journal of Thoracic and Cardiovascular Surgery is a quarterly aimed at cardiologists, cardiosurgeons and thoracic surgeons. Includes the original works (experimental, research and development), illustrative and casuistical works about cardiology and cardiosurgery.
期刊最新文献
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