O'Keefe J H, Kreamer T R, Jones P G, Vacek J L, Gorton M E, Muehlebach G F, Rutherford B D, McCallister B D
Mid America Heart Institute, Kansas City, MO 64111, USA.
Circulation. 1999 Nov 9;100(19 Suppl):II114-8. doi: 10.1161/01.cir.100.suppl_2.ii-114.
Single-vessel coronary artery disease is usually treated with PTCA; however, this approach when applied to the left anterior descending coronary artery (LAD) is hampered by high restenosis rates, often approaching 50%. Coronary stenting (STENT) and left internal mammary artery bypass grafting of the LAD (LIMA-LAD) are other options that have been successfully used for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear. The purpose of the present study was to examine PTCA versus STENT versus LIMA-LAD with respect to short- and intermediate-term outcomes.
This was an observational retrospective cohort study comparing in-hospital and intermediate-term outcomes and functional class among patients with isolated single-vessel LAD disease revascularization. Consecutive eligible patients were grouped according to their initial revascularization procedure and systematically followed up. A total of 704 patients qualified for the study: 469 in the PTCA group, 137 in the STENT group, and 98 in the LIMA-LAD group. Follow-up data were complete for 97% of patients and averaged 27+/-13 months. In-hospital mortality for the PTCA, STENT, and LIMA-LAD groups was 1.1%, 0%, and 0% (P=0.51), respectively. Median hospital stays after the procedure for the respective treatment groups were 1, 1, and 5 days (P<0.001), and occurrences of in-hospital myocardial infarction were 0.9%, 1.5%, and 1.0% (P=NS). Repeat revascularization procedures were performed in 30%, 24%, and 5% of the PTCA, STENT, and LIMA-LAD groups (P=<0. 001 for LIMA-LAD versus other groups, P=0.11 for PTCA versus STENT). Actuarial 2-year mortality was 3.9%, 2.6%, and 1% in the PTCA, STENT, and LIMA-LAD groups (P=0.33).
Revascularization for isolated LAD disease using PTCA, STENT, or LIMA-LAD results in low in-hospital adverse event rates and good long-term results. Repeat procedures are required less often after LIMA-LAD than after either PTCA or STENT. Long-term mortality was not statistically different, but the trend was for the lowest mortality with LIMA-LAD, a somewhat higher mortality with STENT, and the highest mortality with PTCA.
单支冠状动脉疾病通常采用经皮冠状动脉腔内血管成形术（PTCA）治疗；然而，当将此方法应用于左前降支冠状动脉（LAD）时，会受到高再狭窄率的阻碍，再狭窄率常常接近50%。冠状动脉支架置入术（STENT）以及LAD的左乳内动脉搭桥术（LIMA-LAD）是已成功用于单支LAD疾病的其他选择。孤立性单支LAD疾病患者的最佳血运重建方式尚不清楚。本研究的目的是比较PTCA、STENT与LIMA-LAD在短期和中期结局方面的差异。
这是一项观察性回顾性队列研究，比较孤立性单支LAD疾病血运重建患者的住院期间及中期结局和心功能分级。连续入选的合格患者根据其初始血运重建程序进行分组，并进行系统随访。共有704例患者符合研究条件：PTCA组469例，STENT组137例，LIMA-LAD组98例。97%的患者有完整的随访数据，平均随访时间为27±13个月。PTCA组、STENT组和LIMA-LAD组的住院死亡率分别为1.1%、0%和0%（P=0.51）。各治疗组术后的中位住院天数分别为1天、1天和5天（P<0.001），住院期间心肌梗死发生率分别为0.9%、1.5%和1.0%（P=无显著差异）。PTCA组、STENT组和LIMA-LAD组分别有30%、24%和5%的患者进行了再次血运重建程序（LIMA-LAD组与其他组相比P<0.001，PTCA组与STENT组相比P=0.11）。PTCA组、STENT组和LIMA-LAD组的2年精算死亡率分别为3.9%、2.6%和1%（P=0.33）。
使用PTCA、STENT或LIMA-LAD对孤立性LAD疾病进行血运重建，住院期间不良事件发生率低，长期效果良好。与PTCA或STENT相比，LIMA-LAD术后需要再次进行手术的情况较少。长期死亡率无统计学差异，但趋势是LIMA-LAD死亡率最低，STENT死亡率略高，PTCA死亡率最高。
