对无保护左主干冠状动脉狭窄血运重建的临床决策

Clinical Decision of Revascularization for Unprotected Left Main Stem Coronary Artery Stenosis

对于无保护左主干(LMS)狭窄的冠状动脉疾病,冠状动脉旁路移植术(CABG)一直被认为是"标准治疗",原因就是有充分的证据证明其具有远期生存率方面的益处。但是,目前却出现了越来越多的使用药物支架而不是CABG治疗左主干狭窄的趋势,尽管目前这方面的证据还不充分。在此,本文在汇总了经皮血运重建技术(PCI)干预无保护左主干、对比支架和外科手术治疗无保护左主干的随机对照研究资料的基础上,总结认为,对于适合外科手术的无保护左主干狭窄患者,CABG仍旧是血运重建的首选。

For coronary artery disease with unprotected left main stem （LMS） stenosis, coronary artery bypass grafting （CABG） is traditionally regarded as the ＂standard of care＂ because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein： evaluate the current evidence of the use of percutaneous revaseularization intervention（PCI） for unprotected LMS and randomized controlled trials of stenting versus surgery for unprotected LMS. Therefore, we conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis.