LADに対するPCI vs CABGの長期成績（5年）

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

NEJM

○PICO

P： left main coronary artery disease of low or intermediate anatomical complexity (according to assessment at the participating centers)(N=1905)

eligible：stenosis of the left main coronary ar- tery of 70% or more (as estimated visually) or stenosis of 50% to less than 70% (if determined by means of noninvasive or invasive testing to be hemodynamically significant) and if a consensus among the members of the heart team had been reached regarding eligibility for revasculariza- tion with either PCI or CABG。Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score≦32であるlow or intermediate anatomical complexity of coronary artery disease

 

I： PCI with fluoropolymer-based cobalt–chromium everolimus-eluting stents (PCI group, 948 patients)

C：CABG (CABG group, 957 patients)

O： primary outcome→composite of death, stroke, or myocardial infarction at 3 years

○結果

・primary outcome event →22.0% of the patients in the PCI group and in 19.2% of the patients in the CABG group (difference, 2.8 percent- age points; 95% confidence interval [CI], −0.9 to 6.5; P=0.13).

・全死亡率はPCIで増加(in 13.0% vs. 9.9%; difference, 3.1 percentage points; 95% CI, 0.2 to 6.1).

 

LAD病変がありlow to intermediate anatomical complexityがある患者に対するPCI vs CABGのRCT。3年予後に関してはPCIの非劣性が証明されていた。5年予後に関しても同様な結果が示された。しかし、カプランマイヤー曲線を見ると3年からPCIとCABGが交差しており5年ではなく10年などより長期での比較が必要であるかもしれない。