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首页> 外文期刊>JACC. Cardiovascular interventions >Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment
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Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: A multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment

机译：经DELTA注册中心对未保护的左主冠状动脉的经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗眼中/中轴病变的长期临床结果：一个多中心注册中心，评估经皮冠状动脉介入治疗与冠状动脉旁路移植术对左主要治疗方法

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Objectives: The aim of this study was to report the long-term clinical outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for ostial/midshaft lesions in an unprotected left main coronary artery (ULMCA). Background: Data regarding outcomes in these patients are limited. Methods: Of a total of 2,775 patients enrolled in the DELTA multinational registry, 856 patients with isolated ostial/midshaft lesions in an ULMCA treated by PCI with DES (n = 482) or CABG (n = 374) were analyzed. Results: At a median follow-up period of 1,293 days, there were no significant differences in the propensity score-adjusted analyses for the composite endpoint of all-cause death, myocardial infarction (MI), and cerebrovascular accident (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.79 to 1.86; p = 0.372), all-cause death (HR: 1.35, 95% CI: 0.80 to 2.27; p = 0.255), the composite endpoint of all-cause death and MI (HR: 1.33, 95% CI: 0.83 to 2.12; p = 0.235) and major adverse cardiac and cerebrovascular events (HR: 1.34, 95% CI: 0.93 to 1.93; p = 0.113). These results were sustained after propensity-score matching. However, a higher incidence of target vessel revascularization (HR: 1.94, 95% CI: 1.03 to 3.64; p = 0.039) was observed in the PCI compared with the CABG group, with a trend toward higher target lesion revascularization (HR: 2.00, 95% CI: 0.90 to 4.45; p = 0.090). Conclusions: This study demonstrates that PCI for ostial/midshaft lesions in an ULMCA is associated with clinical outcomes comparable to those observed with CABG at long-term follow-up, despite the use of older first-generation DES.
机译：目的：本研究的目的是报告在未保护的左主冠状动脉中经皮冠状动脉介入治疗（PCI）与药物洗脱支架（DES）对比冠状动脉搭桥术（CABG）对眼中/中轴病变的长期临床疗效动脉（ULMCA）。背景：关于这些患者预后的数据有限。方法：在参加DELTA多国注册的2775名患者中，分析了856例经PCI DES（n = 482）或CABG（n = 374）治疗的ULMCA中孤立的听觉/中轴病变的患者。结果：在中位随访期为1,293天，全因死亡，心肌梗死（MI）和脑血管意外（危险比[HR]）的综合终点的倾向性得分调整后的分析没有显着差异。 ：1.21，95％置信区间[CI]：0.79至1.86; p = 0.372），全因死亡（HR：1.35，95％CI：0.80至2.27; p = 0.255），全因死亡的复合终点和MI（HR：1.33，95％CI：0.83至2.12; p = 0.235）和主要的不良心脏和脑血管事件（HR：1.34，95％CI：0.93至1.93; p = 0.113）。这些结果在倾向得分匹配后得以维持。但是，与CABG组相比，PCI中目标血管血运重建的发生率更高（HR：1.94，95％CI：1.03至3.64; P = 0.039），并且有一个目标病变血运重建的趋势（HR：2.00， 95％CI：0.90至4.45; p = 0.090）。结论：这项研究表明，尽管使用了较早的第一代DES，但ULMCA的PCI可以与长期随访的CABG观察到的临床结果相媲美。

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