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基于多项临床研究对左主干病变血运重建策略的思考

杨军芬,臧雁翔,李为民

Chinese Journal of Interventional Cardiology（2020）

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Abstract
左主干病变(left main coronary artery disease,LMCAD)指冠状动脉造影左主干狭窄程度≥50％的病变.左前降支近端以及左回旋支近端狭窄程度≥70％的病变被视为左主干等同病变[1].EXCEL研究[2]与NOBLE研究[3]均是选择LMCAD患者作为研究对象的多中心随机对照试验(randomizedcontrolled trial, RCT),而SYNTAX研究[4]、MAIN-COMPARE研究[5]中均有对LMCAD血运重建长期预后的分析,同时上述研究修改了欧美指南对LMCAD治疗的推荐等级,将经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的等级推荐为Ⅰ类,A级证据[6-7].虽然如此, LMCAD的血运重建治疗策略仍然争议颇多.
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