CAJ | 학술논문

目的：比较冠状动脉旁路移植术（CABG）和药物涂层支架（DES）在治疗无保护左主干病变（ULMCA）上的远期疗效。方法在PubMed、EMBASE和Cochrane数据库检索有关两种方法治疗ULMCA长期随访的研究文献，采用RevMan 5软件进行数据分析，主要结果为死亡、心肌梗死、脑血管事件、靶血管血运重建（TVR）、复合终点事件、主要不良心脑血管事件（MACCE）。结果纳入12篇文献，共7824例。3年以上随访结果显示，DES组在死亡率（RR＝0.86，95%CI 0.67～1.10，P＝0.23）、复合终点事件发生率（RR＝0.86，95%CI 0.61～1.21，P＝0.38）与CABG组相比差异无统计学意义，但DES组TVR风险（RR＝3.67，95%CI 3.08～4.37，P＜0.001）显著增高。亚组分析结果显示：5年随访DES组死亡风险（RR＝0.74，95% CI 0.61～0.89，P＝0.001）、复合终点事件风险（RR＝0.64，95%CI 0.53～0.78，P＜0.001）均比CABG组显著降低，但TVR风险（RR＝4.20，95% CI 3.15～5.60，P＜0.001）仍显著增高。结论 DES与CABG在治疗ULMCA上3年以上死亡率、复合终点事件发生率相当，但DES的TVR风险较高。
목적：비교관상동맥방로이식술（CABG）화약물도층지가（DES）재치료무보호좌주간병변（ULMCA）상적원기료효。방법재PubMed、EMBASE화Cochrane수거고검색유관량충방법치료ULMCA장기수방적연구문헌，채용RevMan 5연건진행수거분석，주요결과위사망、심기경사、뇌혈관사건、파혈관혈운중건（TVR）、복합종점사건、주요불양심뇌혈관사건（MACCE）。결과납입12편문헌，공7824례。3년이상수방결과현시，DES조재사망솔（RR＝0.86，95%CI 0.67～1.10，P＝0.23）、복합종점사건발생솔（RR＝0.86，95%CI 0.61～1.21，P＝0.38）여CABG조상비차이무통계학의의，단DES조TVR풍험（RR＝3.67，95%CI 3.08～4.37，P＜0.001）현저증고。아조분석결과현시：5년수방DES조사망풍험（RR＝0.74，95% CI 0.61～0.89，P＝0.001）、복합종점사건풍험（RR＝0.64，95%CI 0.53～0.78，P＜0.001）균비CABG조현저강저，단TVR풍험（RR＝4.20，95% CI 3.15～5.60，P＜0.001）잉현저증고。결론 DES여CABG재치료ULMCA상3년이상사망솔、복합종점사건발생솔상당，단DES적TVR풍험교고。
Objective To compare the long-term efficacy of coronary artery bypass grafting (CABG) with drug-eluting stent (DES) in patients with unprotected left main coronary artery (ULMCA) disease. Methods Pubmed, EMBASE and Cochrane Library Database were searched for clinical studies that reported long-term outcomes comparing DES with CABG on the treatment of ULMCA disease. The data was analyzed by RevMan5. Primary outcomes were death, myocardial infarction, cerebrovascular accident, major adverse cardiac and cerebrovascular events(MACCE) and target vessel revascularization (TVR). Results At more than three-year follow-up, there was no significant difference between the DES and CABG group in the risk of death(RR=0.86, 95% CI 0.67-1.10, P=0.23) and composite endpoint events(RR=0.86, 95% CI 0.61-1.21, P=0.38). The risk of TVR was significantly higher in the DES group(RR=3.67, 95% CI 3.08-4.37, P<0.001). Subgroup analyzes showed that the risk of death(RR=0.74, 95%CI 0.61-0.89, P=0.001) and composite endpoint events(RR=0.64, 95%CI 0.53-0.78, P<0.001) were lower in DES group comparing with CABG group , but the risk of TVR(RR=4.20, 95%CI 3.15-5.60, P<0.001) was still higher in DES group during five-year follow-up. Conclusion DES is associated with favorable outcomes on death and composite endpoint events comparing to CABG with ULMCA disease, but with a higher risk of TVR.