Liu Pinming, Zhang Shaoling, Schiele François, Meneveau Nicolas, Bassand Jean-Pierre
Department of Medicine, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Chin Med J (Engl). 2003 Jun;116(6):844-8.
To assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention.
Seventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and requiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method).
In the catheter-based angioplasty group, the patients' mean age was 63 +/- 8 years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein IIb/IIIa antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2.90 +/- 0.48 mm. The minimum lumen diameter increased from 1.05 +/- 0.30 mm to 2.40 +/- 0.45 mm, and the diameter stenosis decreased from 64% +/- 7% to 8% +/- 13%. During the follow-up period, adverse events requiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42 +/- 0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant.
Percutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, but has a higher risk of late restenosis and greater need for repeat revascularization than coronary bypass surgery.
评估经皮冠状动脉介入治疗左前降支开口病变的近期和远期临床结果。
17例（6例女性和11例男性）接受经皮冠状动脉介入治疗左前降支开口狭窄的患者进行了为期12个月的临床随访。临床事件定义为死亡、心肌梗死、复发性心绞痛的发生以及需要再次血运重建（通过血管成形术或手术）。根据年龄、左心室射血分数和病变血管数量的相似性选择接受冠状动脉搭桥手术的匹配人群。生成Kaplan-Meier无事件生存曲线，并使用卡方检验（Mc Neimar法）进行匹配比较。
在基于导管的血管成形术组中，患者的平均年龄为63±8岁。1例患者接受了定向旋切术加球囊治疗，6例接受了旋磨术加球囊治疗，7例接受了支架治疗，3例接受了旋磨术加支架治疗。4例使用了糖蛋白IIb/IIIa拮抗剂。所有病例均取得了无重大并发症的初始手术成功。平均参考直径为2.90±0.48mm。最小管腔直径从1.05±0.30mm增加到2.40±0.45mm，直径狭窄从64%±7%降至8%±13%。在随访期间，8例患者发生了需要再次血运重建的不良事件。两年内无事件概率为0.42±0.14。在接受搭桥手术（单支乳内动脉移植）的匹配人群中，仅发生1例事件，两组患者两年内无事件生存的差异具有显著性。
经皮冠状动脉介入治疗左冠状动脉前降支开口病变在技术上是可行且安全的，可获得最佳的早期成功率，但与冠状动脉搭桥手术相比，晚期再狭窄风险更高，且更需要再次血运重建。
