2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG.
2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG.
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DOI：
10.1093/ejcts/ezad286
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发表时间：
2023-08
期刊：
影响因子：
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通讯作者：
R. Byrne;S. Fremes;D. Capodanno;M. Czerny;T. Doenst;J. Emberson;V. Falk;M. Gaudino;J. McMurray;R. Mehran;M. Milojevic;M. Uva
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作者：
R. Byrne;S. Fremes;D. Capodanno;M. Czerny;T. Doenst;J. Emberson;V. Falk;M. Gaudino;J. McMurray;R. Mehran;M. Milojevic;M. Uva
工作组结构和2022年ESC/ECONDITION对2018年左主干冠状动脉疾病血运重建指南建议的审查的临床证据总结。CABG，冠状动脉旁路移植术; PCI，经皮冠状动脉介入治疗; LM，左主干; SYNTAX，TAXUS经皮冠状动脉介入治疗与心脏手术之间的协同作用。a“事件”是指死亡、心肌梗死（根据心肌梗死的通用定义，如果可用，否则方案定义）或卒中的复合事件。2021年10月，欧洲心脏病学会（ESC）和欧洲胸外科协会（ESTRA）共同同意成立一个工作组（TF），以审查2018年ESC/ESTRA指南中关于心肌血运重建的建议，因为它们适用于SYNTAX评分为低至中等（0-32）的左主干（LM）疾病患者。这是在2019年ECOSTA撤回对先前指南中关于LM疾病管理的建议的支持之后。要求TF审查自2018年指南以来的所有新的相关数据，包括比较LM疾病患者经皮冠状动脉介入治疗（PCI）和药物洗脱支架与冠状动脉旁路移植术（CABG）的4项随机试验的更新汇总数据。本文件代表了TF工作的总结;包括了对LM疾病接受心肌血运重建的患者选择血运重建方式的建议和更新建议。在有LM疾病血运重建适应症的稳定患者中，冠状动脉解剖结构适合两种手术，预计手术死亡率较低，TF得出结论，根据患者偏好、可用专业知识和当地术者数量，两种治疗方案在临床上都是合理的。CABG血运重建的建议为I级，证据等级A。PCI的建议为IIa类，证据等级A。TF认识到LM疾病患者血运重建相关知识的几个重要空白，并认识到4项随机试验的汇总数据仍然仅足以排除死亡率的较大差异。
Task Force structure and summary of clinical evidence of 2022 ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease. CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; LM, left main; SYNTAX, Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery. a'Event' refers to the composite of death, myocardial infarction (according to Universal Definition of Myocardial Infarction if available, otherwise protocol defined) or stroke. In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.