无保护左主干病变合并急性冠状动脉综合征介入与手术治疗对比研究

目的:探讨急性冠状动脉综合征(ACS)合并无保护左主干病变患者经桡动脉介入治疗(TRI)与冠状动脉旁路移植术(CABG)二者的疗效。方法:连续入选2008年3月至2010年12月,于北京安贞医院行经桡动脉介入治疗(n=236)或冠状动脉旁路移植术(n=354)的无保护左主干病变合并ACS患者。对于患者的临床基线特征及冠状动脉病变特征纳入倾向性评分模型进行匹配,得到154对患者。结果:平均随访时间27个月。经过倾向性评分模型进行校正,两组患者的基线资料及病变特征无显著差异。结果显示TRI与CABG两组全因病死率(4.5%vs.6.5%;P=0.454)及心肌梗死发生率(5.2%vs.7.8%;P=0.355)并差异无统计学意义。CABG组患者脑卒中发生率显著增加(零vs.2.6%;P=0.044),而TRI组靶血管重建率(TVR)显著增加(13.0%vs.5.2%;P=0.017)。两组患者复合终点(死亡/心肌梗死/靶血管重建),差异无统计学意义(7.1%vs.12.3%;P=0.124)。结论:对于ACS合并无保护左主干病变患者TRI与CABG的临床复合终点事件风险相似,然而尽管应用药物洗脱支架CABG组患者靶血管重建率仍显著低于介入治疗组。

Transradial percutaneous coronary intervention versus coronary artery bypass grafting for unprotected left main disease in patients with acute coronary syndrome

Objective：Previous trials indicated that radial access was superior to conventional femoral access for percutaneous coronary intervention in reducing bleeding and vascular complications in patients with acute coronary syndrome （ACS）.However,inquire into the overall safety and efficacy of transradial coronary intervention （TRI） with drug eluting stent （DES） versus coronary artery bypass grafting （CABG） for patients with unprotected left main disease （UPLM） presenting with ACS.Methods：All consecutive patients with ACS undergoing TRI with DES （n =236） or CABG （n =354） for UPLM lesions in our center,between March 2008 and December 2010,were included.And a propensity-score matching was performed to adjust for differences in baseline clinical and angiographic characteristics between the two cohorts,yielding 154 pairs of matched patients.Results：Median clinical follow-up duration was 27 months.After propensity-score adjustment,baseline comorbidities and angiographic characteristics were similar between two groups.And no significant difference was observed between TRI and CABG group in all cause mortality （4.5％ vs.6.5％ ; P =0.454） and myocardial infarction （MI） （5.2％ vs.7.8％ ; P =0.355）.However,there was a significant increase in the incidence of stroke in CABG group （0 vs.2.6％ ; P =0.044）,while a significantly increased target vessel revascularization （TVR） rate （13.0％ vs.5.2％ ; P =0.017） was observed in TRI group.Composite outcome （death/MI/stroke） was comparable between the TRI and CABG groups （7.1％ vs.12.3％; P =0.124）.Conclusion：Clinical outcomes of TRI with DES on UPLM disease for ACS patients are comparable to CABG in composite safety outcomes including death/MI/stroke.However,CABG is still superior to percutaneous coronary intervention in TVR despite using DES.