BACKGROUND The optimal coronary revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease and left ventricular systolic dysfunction (LVSD) remains uncertain. The purpose of this study was to evaluate the clinical outcomes after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) versus coronary artery bypass grafting (CABG) in patients with ULMCA disease with or without LVSD. METHODS A total of 984 patients with ULMCA disease who received a DES (n = 511) or underwent CABG (n = 473) were included in this study. We retrospectively analyzed the clinical parameters and outcomes of ULMCA disease patients with different left ventricular ejection fraction levels. RESULTS There were no significant differences in major adverse cardiac and cerebral events, all-cause death, cardiac death, myocardial infarction, or stroke between the CABG and DES groups with or without LVSD. The rate of target vessel revascularization was significantly higher with DES compared with CABG in patients without LVSD; however, the difference was not significant between the mild LVSD and severe LVSD groups. CONCLUSION For patients with ULMCA disease and LVSD, there was no significant difference between DES and CABG in terms of efficacy and safety. Treatment with DES was an acceptable alternative to CABG.

中文翻译：

---

无保护的左主干冠状动脉疾病患者的左心室收缩功能障碍。

背景 对于无保护的左主干冠状动脉 (ULMCA) 疾病和左心室收缩功能障碍 (LVSD) 的患者，最佳冠状动脉血运重建策略仍不确定。本研究的目的是评估 ULMCA 疾病伴或不伴 LVSD 的经皮冠状动脉介入治疗 (PCI) 与药物洗脱支架 (DES) 与冠状动脉旁路移植术 (CABG) 后的临床结果。方法 本研究共纳入 984 名接受 DES（n = 511）或接受 CABG（n = 473）的 ULMCA 疾病患者。我们回顾性分析了不同左心室射血分数水平的 ULMCA 疾病患者的临床参数和结局。结果 主要不良心脑事件、全因死亡、心源性死亡、CABG 和 DES 组之间有或没有 LVSD 的心肌梗塞或中风。在没有 LVSD 的患者中，与 CABG 相比，DES 的靶血管血运重建率显着更高；然而，轻度 LVSD 组和重度 LVSD 组之间的差异不显着。结论 ULMCA 病变合并 LVSD 患者，DES 与 CABG 在疗效和安全性方面无显着差异。DES 治疗是 CABG 的可接受替代方案。DES和CABG在疗效和安全性方面没有显着差异。DES 治疗是 CABG 的可接受替代方案。DES和CABG在疗效和安全性方面没有显着差异。DES 治疗是 CABG 的可接受替代方案。