Huang Hsuan-Li, Hsieh I-Chang, Chang Shang-Hung, Chang Hern-Jia, Chen Chun-Chi, Hung Kuo-Chun, Wen Ming-Shien, Wu Delon
Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
Int J Cardiol. 2005 Jun 8;101(3):391-7. doi: 10.1016/j.ijcard.2004.03.055.
Percutaneous transluminal coronary angioplasty in ostial lesions is technically difficult and is associated with a lower procedural success rate, higher complication rate and restenosis rate as compared to nonostial lesions. The safety, feasibility, immediate and 6-month angiographic, and long-term clinical outcomes of stenting in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial stenoses, were retrospectively compared in 19 patients with 20 aorto-ostial lesions (group A), 97 with 97 LAD-ostial lesions (group B) and 1778 with 2242 nonostial lesions (group C). The major adverse cardiac events during hospitalization were similar among the three groups (p = 0.816). Twelve patients with 12 lesions in group A, 75 with 75 lesions in group B and 1384 with 1749 lesions in group C underwent a 6-month follow-up coronary angiography. There were no differences in acute gain (2.04 +/- 0.46 vs. 2.34 +/- 0.50 vs. 2.39 +/- 0.54 mm, respectively, p = 0.057) and net gain (0.89 +/- 1.02 vs. 1.26 +/- 1.08 vs. 1.34 +/- 0.76 mm, respectively, p = 0.105) among the three groups. Group B had a larger late loss than group A and C (1.15 +/- 1.01 vs. 1.22 +/- 0.76 vs. 1.04 +/- 0.65 mm, respectively, p = 0.048) and group A had a larger loss index than group B and C (0.59 +/- 0.50 vs. 0.52 +/- 0.31 vs. 0.48 +/- 0.29, respectively, p = 0.027). The binary restenosis rate among the three groups was 33%, 29% and 20%, respectively, (p = 0.072). Group B had higher restenotic rate as compared to group C (p = 0.036). During a long-term follow-up period of 42+/-21 months, major adverse cardiac events were similar among the three groups (15.8% vs. 25.8% vs. 20.1%, respectively, p = 0.362), but group B had a higher incidence of recurrent angina as compared to group C (17.5% vs. 10.9%, p = 0.039). The cardiac event-free survival rate, as determined by Kaplan-Meier analysis, was similar among the three groups (56% vs. 57% vs. 67%, respectively, p = 0.149); a borderline significance was noted as compared group B to group C (p = 0.051). In conclusion, stenting in aorto-ostial or LAD-ostial lesions is safe, feasible and has a similar acute result as compared to stenting in nonostial lesions; however, it still has a higher 6-month angiographic restenosis rate. LAD-ostial stenoses may have a less favorable long-term clinical outcome than nonostial stenoses.
与非开口处病变相比，经皮腔内冠状动脉成形术治疗开口处病变在技术上难度较大，且手术成功率较低，并发症发生率和再狭窄率较高。对19例有20处主动脉开口处病变的患者（A组）、97例有97处左前降支开口处病变的患者（B组）和1778例有2242处非开口处病变的患者（C组）进行回顾性比较，分析在主动脉开口处、左前降支开口处和非开口处狭窄病变中置入支架的安全性、可行性、即刻及6个月血管造影结果以及长期临床结局。三组患者住院期间的主要不良心脏事件相似（p = 0.816）。A组12例患者有12处病变、B组75例患者有75处病变、C组1384例患者有1749处病变接受了6个月的随访冠状动脉造影。三组间急性增益（分别为2.04±0.46 vs. 2.34±0.50 vs. 2.39±0.54 mm，p = 0.057）和净增益（分别为0.89±1.02 vs. 1.26±1.08 vs. 1.34±0.76 mm，p = 0.105）无差异。B组的晚期丢失大于A组和C组（分别为1.15±1.01 vs. 1.22±0.76 vs. 1.04±0.65 mm，p = 0.048），A组的丢失指数大于B组和C组（分别为0.59±0.50 vs. 0.52±0.31 vs. 0.48±0.29，p = 0.027）。三组的二元再狭窄率分别为33%、29%和20%（p = 0.072）。B组的再狭窄率高于C组（p = 0.036）。在42±21个月的长期随访期内，三组的主要不良心脏事件相似（分别为15.8% vs. 25.8% vs. 20.1%，p = 0.362），但B组复发性心绞痛的发生率高于C组（17.5% vs. 10.9%，p = 0.039）。根据Kaplan-Meier分析确定的无心脏事件生存率三组相似（分别为56% vs. 57% vs. 67%，p = 0.149）；B组与C组比较有临界显著性（p = 0.051）。总之，在主动脉开口处或左前降支开口处病变中置入支架是安全、可行的，与非开口处病变置入支架相比急性结果相似；然而，其6个月血管造影再狭窄率仍较高。左前降支开口处狭窄的长期临床结局可能不如非开口处狭窄。
