Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease

被引：578

作者：

Stone, G. W. ^{[1
,2
]}

Kappetein, A. P. ^{[6
]}

Sabik, J. F. ^{[9
]}

Pocock, S. J. ^{[10
]}

Morice, M. -C. ^{[14
]}

Puskas, J. ^{[3
]}

Kandzari, D. E. ^{[15
]}

Karmpaliotis, D. ^{[2
,4
,5
]}

Brown, W. M., III ^{[15
]}

Lembo, N. J. ^{[2
,4
,5
]}

Banning, A. ^{[12
]}

Merkely, B. ^{[16
]}

Horkay, F. ^{[16
]}

Boonstra, P. W. ^{[7
]}

van Boven, A. J. ^{[7
]}

Ungi, I. ^{[17
]}

Bogats, G. ^{[17
]}

Mansour, S. ^{[18
]}

Noiseux, N. ^{[18
]}

Sabate, M. ^{[20
]}

Pomar, J. ^{[20
]}

Hickey, M. ^{[13
]}

Gershlick, A. ^{[13
]}

Buszman, P. E. ^{[21
,22
]}

Bochenek, A. ^{[21
,22
]}

Schampaert, E. ^{[19
]}

Page, P. ^{[19
]}

Modolo, R. ^{[8
,23
]}

Gregson, J. ^{[10
]}

Simonton, C. A. ^{[24
]}

Mehran, R. ^{[1
,2
]}

Kosmidou, I. ^{[2
,4
,5
]}

Genereux, P. ^{[2
,19
,25
]}

Crowley, A. ^{[2
]}

Dressler, O. ^{[2
]}

Serruys, P. W. ^{[11
]}

机构：

[1] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA

[2] Cardiovasc Res Fdn, New York, NY 10019 USA

[3] Mt Sinai St Lukes, Mt Sinai Heart, New York, NY USA

[4] New York Presbyterian Hosp, New York, NY USA

[5] Columbia Univ, Med Ctr, New York, NY USA

[6] Erasmus MC, Rotterdam, Netherlands

[7] Med Ctr Leeuwarden, Leeuwarden, Netherlands

[8] Univ Amsterdam, Acad Med Ctr, Amsterdam, Netherlands

[9] Univ Hosp Cleveland, Med Ctr, Cleveland, OH 44106 USA

[10] London Sch Hyg & Trop Med, London, England

[11] Imperial Coll London, Natl Heart & Lung Inst, Int Ctr Circulatory Hlth, London, England

[12] John Radcliffe Hosp, Oxford, England

[13] Univ Hosp Leicester NHS Trust, Leicester, Leics, England

[14] Hop Prive Jacques Cartier, Ramsay Gen Sante, Massy, France

[15] Piedmont Heart Inst, Atlanta, GA USA

[16] Semmelweis Univ, Budapest, Hungary

[17] Univ Szeged, Szeged, Hungary

[18] CHU Montreal, Montreal, PQ, Canada

[19] Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[20] Hosp Clin Barcelona, Barcelona, Spain

[21] Med Univ Silesia, Katowice, Poland

[22] Amer Heart Poland, Ustron, Poland

[23] Univ Estadual Campinas, Campinas, SP, Brazil

[24] Abbott Vasc, Santa Clara, CA USA

[25] Morristown Med Ctr, Gagnon Cardiovasc Inst, Morristown, NJ USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2019年 / 381卷 / 19期

关键词：

EVEROLIMUS-ELUTING STENTS; BYPASS-SURGERY; ARTERY-DISEASE; REPEAT REVASCULARIZATION; MYOCARDIAL-INFARCTION; CLINICAL-OUTCOMES; INTERVENTION; DEFINITION; TRIALS;

D O I：

10.1056/NEJMoa1909406

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

In a randomized trial, 1905 patients with left main coronary artery disease were assigned to either percutaneous coronary intervention (PCI) or coronary-artery bypass grafting (CABG). At 5 years, the rates of the composite of death, stroke, or myocardial infarction were not significantly different between the two groups. Background Long-term outcomes after percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary-artery bypass grafting (CABG), in patients with left main coronary artery disease are not clearly established. Methods We randomly assigned 1905 patients with left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers) to undergo either PCI with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). The primary outcome was a composite of death, stroke, or myocardial infarction. Results At 5 years, a primary outcome event had occurred in 22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percentage points; 95% confidence interval [CI], -0.9 to 6.5; P=0.13). Death from any cause occurred more frequently in the PCI group than in the CABG group (in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1). In the PCI and CABG groups, the incidences of definite cardiovascular death (5.0% and 4.5%, respectively; difference, 0.5 percentage points; 95% CI, -1.4 to 2.5) and myocardial infarction (10.6% and 9.1%; difference, 1.4 percentage points; 95% CI, -1.3 to 4.2) were not significantly different. All cerebrovascular events were less frequent after PCI than after CABG (3.3% vs. 5.2%; difference, -1.9 percentage points; 95% CI, -3.8 to 0), although the incidence of stroke was not significantly different between the two groups (2.9% and 3.7%; difference, -0.8 percentage points; 95% CI, -2.4 to 0.9). Ischemia-driven revascularization was more frequent after PCI than after CABG (16.9% vs. 10.0%; difference, 6.9 percentage points; 95% CI, 3.7 to 10.0). Conclusions In patients with left main coronary artery disease of low or intermediate anatomical complexity, there was no significant difference between PCI and CABG with respect to the rate of the composite outcome of death, stroke, or myocardial infarction at 5 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776.)

引用

页码：1820 / 1830

页数：11

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