主动脉开口处、左前降支动脉开口处和非开口处狭窄患者冠状动脉内支架置入的急性和长期预后

Acute and long-term outcomes of intracoronary stenting in aorto-ostial, left anterior descending artery-ostial and nonostial stenoses.

作者信息

Huang Hsuan-Li, Hsieh I-Chang, Chang Shang-Hung, Chang Hern-Jia, Chen Chun-Chi, Hung Kuo-Chun, Wen Ming-Shien, Wu Delon

机构信息

Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.

出版信息

Int J Cardiol. 2005 Jun 8;101(3):391-7. doi: 10.1016/j.ijcard.2004.03.055.

DOI:10.1016/j.ijcard.2004.03.055

PMID:15907406

Abstract

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.

摘要

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。