López-Palop Ramón, Pinar Eduardo, Saura Daniel, Pérez-Lorente Fernando, Lozano Iñigo, Teruel Francisca, Hurtado José, Lacunza Javier, Picó Francisco, Valdés Mariano
Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Rev Esp Cardiol. 2004 Nov;57(11):1035-44.
Surgical revascularization is the procedure of choice for unprotected left main coronary artery stenosis, but it may be unsuitable in some patients. We report short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis in a series of patients who were poor candidates for surgery.
Descriptive study of a historic cohort of consecutive patients with unprotected left main coronary artery stenosis who were not candidates for surgery, treated with percutaneous coronary intervention at a single center between April 1999 and December 2003.
A total of 83 patients (mean age 72 [9] years) were included. Twenty patients (24%) were in shock on presentation. Surgery was considered unsuitable because of unacceptable surgical risk, poor condition of the distal vessels or comorbid conditions in 61 (73.5%) patients, or acute myocardial infarction in 22 (27%). An intraaortic balloon pump was used in 34 (40%); abciximab in 30 (36%) and stenting in 79 (95%) procedures. The intervention was considered successful in 76 patients (92%). Total in-hospital mortality was 28.9% (55% in patients with acute myocardial infarction and 20% in those without acute myocardial infarction). Median follow-up was 17 months. Average survival was 19.7 (2) months. Eighteen (22%) patients were hospitalized again for a new ischemic event, and 14 (17%) underwent revascularization. In 9 cases (10.8%) a new angioplasty was performed, and in 5 (6.0%) surgical revascularization was necessary.
Percutaneous coronary intervention is an option for revascularization in left main coronary artery stenosis in patients who are poor candidates for surgery, although in-hospital and long-term mortality remain high.
外科血管重建术是无保护左主干冠状动脉狭窄的首选治疗方法，但在某些患者中可能并不适用。我们报告了一系列不适合手术的患者接受经皮冠状动脉介入治疗无保护左主干冠状动脉狭窄的短期和中期结果。
对1999年4月至2003年12月在单一中心接受经皮冠状动脉介入治疗的连续无保护左主干冠状动脉狭窄且不适合手术的患者进行历史性队列描述性研究。
共纳入83例患者（平均年龄72[9]岁）。20例（24%）患者就诊时处于休克状态。61例（73.5%）患者因手术风险不可接受、远端血管状况差或合并症而被认为不适合手术，22例（27%）患者因急性心肌梗死而不适合手术。34例（40%）患者使用了主动脉内球囊泵；30例（36%）患者使用了阿昔单抗，79例（95%）手术使用了支架。76例患者（92%）的介入治疗被认为成功。院内总死亡率为28.9%（急性心肌梗死患者中为55%，无急性心肌梗死患者中为20%）。中位随访时间为17个月。平均生存期为19.7（2）个月。18例（22%）患者因新的缺血事件再次住院，14例（17%）患者接受了血管重建术。9例（10.8%）患者进行了新的血管成形术，5例（6.0%）患者需要进行外科血管重建术。
对于不适合手术的患者，经皮冠状动脉介入治疗是无保护左主干冠状动脉狭窄血管重建的一种选择，尽管院内和长期死亡率仍然很高。
