Martí Vicens, Planas Francesc, Cotes Carlos, García Joan, Guiteras Pere, López Laura, Augé Josep M
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Rev Esp Cardiol. 2004 Nov;57(11):1029-34.
Coronary artery bypass graft surgery is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. The aim of the present study was to analyze the immediate and long-term results of angioplasty with stenting of the left main coronary artery, and to identify factors predictive of death.
A total of 38 nonconsecutive patients (mean age 69 [8] years) with a severe lesion in the left main coronary artery were treated with angioplasty and stenting between November 1997 and March 2003. The procedure was elective in 27 patients and urgent in the remaining 11. In 23 patients (60.5%) the left main coronary artery was not protected by aortocoronary bypass. All patients underwent clinical follow-up examination at 25 (20) months.
Angiographically documented success was obtained in all patients. However, one patient died from acute occlusion one hour after the operation. Four patients (10%) had a non-Q-wave myocardial infarction. In-hospital mortality was 15.8% (6/38 patients). Five of the 11 patients (45.4%) who underwent emergency angioplasty and stenting died in the hospital from acute myocardial infarction complicated by severe (Killip grade III-IV) heart failure. However, only one of 27 patients (3.7%) in the elective surgery group died (P=.007). Major clinical cardiac events during follow-up occurred in 5 patients (13%); 3 died and the other 2 had recurrent angina. All patients who died had an unprotected left main coronary artery. Cumulative survival rates for the elective group were 92 (0.5)% at 6 months, 88 (0.6)% at 1 year and 86 (0.7)% at 3 years, respectively. For the emergency surgery group cumulative survival rate was 54 (0.2)% at 6 months (P<.05).
Elective angioplasty and stenting of the left main coronary artery in selected patients was associated with a high immediate success rate. In patients who underwent elective angioplasty and stenting, the incidence of major cardiac events during follow-up was relatively low. Emergency angioplasty and signs of left ventricular dysfunction were the main predictors of in-hospital mortality.
冠状动脉旁路移植术是严重左主干冠状动脉狭窄的首选治疗方法。多项多中心试验结果表明，血管成形术加支架置入术可能是一种替代治疗方法。本研究的目的是分析左主干冠状动脉血管成形术加支架置入术的近期和长期结果，并确定预测死亡的因素。
1997年11月至2003年3月期间，共对38例非连续性左主干冠状动脉严重病变患者（平均年龄69[8]岁）进行了血管成形术和支架置入术治疗。27例患者为择期手术，其余11例为急诊手术。23例患者（60.5%）的左主干冠状动脉未接受主动脉冠状动脉旁路移植术保护。所有患者均在25（20）个月时接受了临床随访检查。
所有患者血管造影显示手术成功。然而，1例患者术后1小时因急性闭塞死亡。4例患者（10%）发生非Q波心肌梗死。住院死亡率为15.8%（6/38例患者）。11例接受急诊血管成形术和支架置入术的患者中有5例（45.4%）因急性心肌梗死并发严重（Killip III-IV级）心力衰竭在医院死亡。然而，择期手术组27例患者中只有1例（3.7%）死亡（P = 0.007）。随访期间主要心脏临床事件发生在5例患者（13%）；3例死亡，另外2例有心绞痛复发。所有死亡患者的左主干冠状动脉均未得到保护。择期手术组6个月、1年和3年的累积生存率分别为92（0.5）%、88（0.6）%和86（0.7）%。急诊手术组6个月的累积生存率为54（0.2）%（P < 0.05）。
在选定患者中对左主干冠状动脉进行择期血管成形术和支架置入术成功率高。接受择期血管成形术和支架置入术的患者随访期间主要心脏事件发生率相对较低。急诊血管成形术和左心室功能障碍迹象是住院死亡率的主要预测因素。
