[中国无保护左主干冠状动脉支架置入术后的近期和长期预后——中国无保护左主干冠状动脉支架置入注册研究（CHANCE研究）]

[The immediate and long-term prognosis following unprotected left main coronary artery stenting in Chinese--Chinese Registry of Unprotected Left Main Coronary Artery Stenting (CHANCE Study)].

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2005 Mar;33(3):210-5.

Abstract

OBJECTIVE

To evaluate the immediate and long-term outcomes of unprotected left main coronary artery (LMCA) stenting in Chinese patients and to approach the factors affecting the outcomes.

METHODS

This was a multicenter retrospective registry study. From May 1997 to March 2003 all patients in 23 hospitals undergone elective unprotected LMCA stenting with bare metal stents were enrolled into the registry. All patients enrolled were filled in a Case Report Form.

RESULTS

224 patients were enrolled into the registry, including 166 male (74.1%) and 58 female (25.9%), with mean age of 60.1 +/- 12.0 (22 - 88) years. There were 53 cases (23.7%) with prior myocardial infarction (MI) and 45 cases (20.1%) with diabetes mellitus. Isolated LMCA stenosis was in 126 cases (56.2%) and combined with multivessel disease in 98 cases (43.8%). Mean left ventricular EF was 63.9% +/- 12.3%. Stents were successfully implanted into LMCA in 223 cases (99.6%) and into non-LMCA in 91 cases (92.9%). In-hospital death developed in 1 case (0.45%), now-Q wave MI in 1 case (0.45%). The patients were followed up to 15.6 +/- 12.3 months. Death developed in 12 cases (5.4%), including cardiac death in 10 cases (4.5%) and non-cardiac death in 2 cases (0.9%), MI in 4 cases (1.8%), TLR of LMCA in 26 cases (11.7%) and accumulated MACE in 36 cases (16.1%). LVEF < 40%, female and LMCA combined with multivessel disease increased mortality, combined multivessel diseases with incomplete revascularization increased MACE. Logistic regression analysis revealed that LVEF < 40% and female were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The binary restenosis rate was 31.4% (in 32 cases).

CONCLUSION

Stenting for selected patients with unprotected LMCA stenosis is feasible and safe. Currently, unprotected LMCA stenting should be performed in patients with LVEF >or= 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization could be obtained or inoperable patients.

摘要

目的

评估中国患者无保护左主干冠状动脉（LMCA）支架置入的近期和长期疗效，并探讨影响疗效的因素。

方法

这是一项多中心回顾性注册研究。1997年5月至2003年3月期间，23家医院所有接受裸金属支架择期无保护LMCA支架置入的患者被纳入该注册研究。所有纳入患者均填写病例报告表。

结果

224例患者被纳入该注册研究，其中男性166例（74.1%），女性58例（25.9%），平均年龄60.1±12.0（22 - 88）岁。既往有心肌梗死（MI）53例（23.7%），有糖尿病45例（20.1%）。孤立性LMCA狭窄126例（56.2%），合并多支血管病变98例（43.8%）。平均左心室射血分数（EF）为63.9%±12.3%。223例（99.6%）成功将支架植入LMCA（左主干），91例（92.9%）成功植入非LMCA血管。院内死亡1例（0.45%），非Q波心肌梗死1例（0.45%）。对患者随访15.6±12.3个月。死亡12例（5.4%），其中心脏性死亡10例（4.5%），非心脏性死亡2例（0.9%）；心肌梗死4例（1.8%）；左主干靶病变血管重建（TLR）26例（11.7%）；累计主要不良心血管事件（MACE）36例（16.1%）。左心室射血分数<40%、女性以及LMCA合并多支血管病变增加死亡率，合并多支血管病变且血运重建不完全增加MACE。Logistic回归分析显示，左心室射血分数<40%和女性是心脏性死亡和MACE的独立预测因素。102例（45.7%）患者接受了随访血管造影。二元再狭窄率为31.4%（32例）。