Prognostic Comparison Of Percutaneous Coronary Intervention And Coronary Artery Bypass Grafting In Non-ST-Segment Elevation Acute Coronary Syndrome Patients Treated With SYNTAX Score In Moderate-risk Patients With Unprotected Left Main Disease

OBJECTIVE: To compare the incidence of MACCE events after one year of PCI and CABG in NSTEACS patients with unprotected left main stem lesions in the SYNTAX intermediate-risk group under different risk stratifications,and to investigate the optimal revascularization program.Methods: Retrospectively included unstable angina pectoris and non-ST segment elevation myocardial infarction patients with unprotected left main stem lesions treated at the Tianjin Chest Hospital from 2015.1.1-2016.12.31;the selected cases were all based on the results of coronary angiography.A SYNTAX score was performed and confirmed as a SYNTAX score in the middle-risk group(SYNTAX score 23-32).Patients were divided into PCI group and CABG group according to different treatment methods.Patients with unstable angina were divided into low-risk group and middle-high-risk group by TIMI patientsscores,and patients with NSTEMI were divided into low-risk group and middle-high-risk group by GRACE scores.The selected patients were followed up for 12 months.The follow-up method was telephone follow-up or the patient was readmitted again.The primary outcome measure was the major adverse cerebro-cardiovascular event(MACCE),which included the sum of all-cause death,non-fatal acute myocardial infarction,target vessel revascularization,and non-fatal cerebrovascular events.The second outcones were all-cause death,non-fatal acute myocardial infarction,target lesion revascularization,and non-fatal cerebrovascular events.Results:(1)Compared with CABG group,there was no significant difference in age,gender,disease composition between the two groups.There was no significant difference in the incidence of MACCE events,all-cause death,non-fatal acute myocardial infarction,target lesion revascularization,and non-fatal cerebrovascular events between the PCI and CABG groups(P>0.05).(2)In each group comparison,the incidence of MACCE events was higher in patients treated with PCI in the high-and middle-risk group than in the CABG group(18 cases(20.7%)vs 6 cases(8.7%),P=0.039),while the low-risk group was There was no statistical difference in MACCE incidence,all-cause mortality,non-fatal acute myocardial infarction,target lesion revascularization,and non-fatal cerebrovascular events.(3)Survival analysis showed that the survival rate of CABG in the high-and middle-risk group was significantly higher than that in the PCI group(P=0.024),and the survival rate of the low-risk group after CABG treatment was not significantly different from that in the PCI group(P = 0.201;P = 0.869).(4)COX analysis showed that women,age,smoking,and LDL levels were risk factors for MACCE events in NSTEACS patients with left main disease(P<0.05).Conclusion: Patients with NSTEACS with SYNTAX score in the left main coronary artery disease group may choose appropriate revascularization programs according to different risk stratification.Among them,patients with moderate-to-high-risk patients who choose CABG therapy may be more likely to improve their prognosis.For low-risk patients,PCI can be an effective alternative treatment for CABG.