Left Main Coronary Artery Disease: Secular Trends in Patient Characteristics, Treatments, and Outcomes

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• 作者：Pil Hyung Lee ; MD^a ; Jung-Min Ahn ; MD^a ; Mineok Chang ; MD^a ; Seunghee Baek ; PhD^b ; Sung-Han Yoon ; MD^a ; Soo-Jin Kang ; MD ; PhD^a ; Seung-Whan Lee ; MD ; PhD^a ; Young-Hak Kim ; MD ; PhD^a ; Cheol Whan Lee ; MD ; PhD^a ; Seong-Wook Park ; MD ; PhD^a ; Duk-Woo Park ; MD ; PhD^a ; ^{dwpark@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Seung-Jung Park ; MD ; PhD^a
• 关键词：clinical decision making ; coronary artery bypass ; coronary disease ; percutaneous coronary intervention ; revascularization ; stents
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：13 September 2016
• 年：2016
• 卷：68
• 期：11
• 页码：1233-1246
• 全文大小：1009 K

文摘

Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity. However, how the characteristics, treatment, and clinical outcomes of patients with unprotected LMCA disease have evolved over time has not yet been fully evaluated. We therefore described secular trends in the characteristics and long-term outcomes of unprotected LMCA disease using “real-world” clinical experience from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry together with a broad review of this topic.