Kosuga K, Tamai H, Ueda K, Hsu Y S, Kawashima A, Tanaka S, Matsui S, Hata T, Minami M, Nakamura T, Toma M, Motohara S, Uehata H
Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan.
Am J Cardiol. 1999 Jan 1;83(1):32-7. doi: 10.1016/s0002-9149(98)00778-4.
Angioplasty of the unprotected left main coronary artery (LMCA) has been controversial. Although recent single-center studies suggest that new devices may change the situation, many questions and problems remain. Therefore, the results of unprotected left main coronary angioplasty of 175 procedures in 107 patients were analyzed to evaluate its feasibility and effectiveness. The treatment of the initial 107 cases included balloon angioplasty (39 cases, 36%), directional coronary atherectomy (53 cases, 50%), and stents (15 cases, 14%). They were divided into 3 major subgroups: (1) acute group (n = 14), in which LMCA angioplasty was performed in patients with acute myocardial infarction; (2) emergency group (n = 10); and (3) elective group (n = 83). In-hospital mortality was higher in the acute (35.7%) and emergency (40.0%) groups than in the elective group (3.6%; p <0.0001). Angiographic follow-up was routinely performed and the restenosis rate including in-hospital restenosis was 70% in the acute group, 37.5% in the emergency group, and 40% in the elective group (p = NS). The mean clinical follow-up period was 2.9 years, and the estimated 5-year survival rates of the acute and emergency groups were 50% and 48.2%, respectively. However the 5-year survival rate of the elective group was higher than that seen in the acute or emergency group (77.5%; p <0.05). Repeat LMCA angioplasty was performed in 37 of 68 patients with 8.8% mortality (38.5% of acute and emergency cases and 1.8% of elective cases). The results indicated that elective unprotected LMCA angioplasty is relatively feasible and effective under scheduled angiographic follow-up.
非保护左主干冠状动脉（LMCA）血管成形术一直存在争议。尽管近期的单中心研究表明新设备可能会改变这种情况，但仍存在许多问题。因此，分析了107例患者175例非保护左主干冠状动脉血管成形术的结果，以评估其可行性和有效性。最初107例患者的治疗包括球囊血管成形术（39例，36%）、定向冠状动脉斑块旋切术（53例，50%）和支架置入术（15例，14%）。他们被分为3个主要亚组：（1）急性组（n = 14），即对急性心肌梗死患者进行LMCA血管成形术；（2）急诊组（n = 10）；（3）择期组（n = 83）。急性组（35.7%）和急诊组（40.0%）的院内死亡率高于择期组（3.6%；p <0.0001）。常规进行血管造影随访，急性组包括院内再狭窄在内的再狭窄率为70%，急诊组为37.5%，择期组为40%（p =无显著性差异）。平均临床随访期为2.9年，急性组和急诊组的估计5年生存率分别为50%和48.2%。然而，择期组的5年生存率高于急性组或急诊组（77.5%；p <0.05）。68例患者中有37例进行了重复LMCA血管成形术，死亡率为8.8%（急性和急诊病例的38.5%，择期病例的1.8%）。结果表明，在计划的血管造影随访下，择期非保护LMCA血管成形术相对可行且有效。
