目的:本文探讨了左主干血运重建的最新进展,重点评估最新的美国和欧洲指南。
结果:来自4项针对左主干冠状动脉狭窄的主要随机对照试验(RCT)的最新汇总数据分析表明,CABG在避免主要不良心血管事件方面优于PCI。尽管在5年时观察到的死亡率没有显着差异。其他数据支持CABG用于左心室功能障碍患者,复杂的左主要病变,弥漫性冠状动脉疾病,和糖尿病。
结论:支持每种血运重建方式(PCI与CABG)指南的数据必须考虑病变复杂性等因素,糖尿病,和左心室功能障碍。此外,必须根据这些血运重建技术的最新进展来确定指南所依据的四个主要RCT的结果.
OBJECTIVE: This article explores recent developments in left main revascularization, with a focus on appraising the latest American and European
guidelines.
RESULTS: Recent pooled data analysis from four major randomized controlled trials (RCTs) for left main coronary artery stenosis indicate an advantage for CABG over PCI in regard to freedom from major adverse cardiovascular events, despite no significant difference in mortality observed at 5 years. Additional data support the use of CABG for patients with left ventricular dysfunction, complex left main lesions, diffuse coronary disease, and diabetes.
CONCLUSIONS: The data underpinning the
guidelines on each revascularization modality (PCI versus CABG) must consider factors such as lesion complexity, diabetes, and left ventricular dysfunction. Additionally, the findings of the four major RCTs upon which the
guidelines are based must be ascertained in light of the latest advancements in these revascularization techniques.