Guardado Jorge Humberto, Moreno Raúl, Costa João, Perez-Viscayno Maria J, Segura Luís, Alfonso Fernando, Hernández Rosana, Escaned Javier, Bañuelos Camiño, Macaya Carlos
Hospital Clinico San Carlos, Madrid, Spain.
Arq Bras Cardiol. 2007 Feb;88(2):159-66. doi: 10.1590/s0066-782x2007000200005.
To assess the clinical prognosis of patients with coronary artery diseases undergoing percutaneous revascularization with drug-eluting stent implantation in the proximal left anterior descending coronary artery.
One hundred and seventy consecutive patients with mean age of 65 years, 49 of them females (29%), undergoing implantation of at least one drug-eluting stent in our medical center. The total number of drug-eluting stents implanted was 189, of which 115 (61%) were sirolimus-eluting (CYPHER) and 74 (39%) were paclitaxel-eluting stents (TAXUS). In 100 (60%) of the cases, multivessel coronary artery disease was present. In 61 (36%) patients another coronary artery segment was treated in addition to the proximal left anterior descending coronary artery. The mean clinical follow-up period was 11 +/- 5 months, and angiographic controls were performed between 6 and 9 months. The final endpoint was a composite of death, acute myocardial infarction and need for reintervention on the anterior descending. The secondary endpoint included the occurrence of restenosis, need for reintervention on the proximal segment of the left anterior descending and stent thrombosis.
The procedure achieved immediate angiographic success in all patients. Two deaths, two acute myocardial infarctions, and two percutaneous coronary reinterventions due to stent thrombosis were recorded during in-hospital stay. At the sixth month of follow-up, an additional cardiac death and three myocardial infarctions were observed; three repeat revascularization procedures were required. Up to the end of the follow-up, three additional deaths, three myocardial infarctions and eight revascularization procedures of the anterior descending, two of them surgical, were verified. Survival free from major adverse cardiac events was 91%. Cardiac mortality was 3%. Binary restenosis in the proximal segment of the left anterior descending coronary artery was 4.1%. Target vessel revascularization-free survival was 94%. No cases of late stent thrombosis were observed.
Percutaneous revascularization of the proximal left anterior descending coronary artery with implantation of drug-eluting stents is a safe and very efficient therapeutic strategy in the short and long terms.
评估在左冠状动脉前降支近端植入药物洗脱支架进行经皮血管重建的冠心病患者的临床预后。
连续170例平均年龄65岁的患者，其中49例为女性（29%），在我们医疗中心接受至少一枚药物洗脱支架植入。植入的药物洗脱支架总数为189枚，其中115枚（61%）为西罗莫司洗脱支架（CYPHER），74枚（39%）为紫杉醇洗脱支架（TAXUS）。100例（60%）患者存在多支冠状动脉病变。61例（36%）患者除左冠状动脉前降支近端外，另一冠状动脉节段也接受了治疗。平均临床随访期为11±5个月，在6至9个月期间进行血管造影复查。最终终点为死亡、急性心肌梗死和前降支再次干预需求的复合终点。次要终点包括再狭窄的发生、左冠状动脉前降支近端再次干预需求和支架血栓形成。
该手术在所有患者中均取得即刻血管造影成功。住院期间记录到2例死亡、2例急性心肌梗死和2例因支架血栓形成进行的经皮冠状动脉再次干预。随访至第6个月时，观察到1例额外的心源性死亡和3例心肌梗死；需要进行3例重复血管重建手术。至随访结束时，证实又有3例死亡、3例心肌梗死和8例前降支血管重建手术，其中2例为外科手术。无主要不良心脏事件的生存率为91%。心源性死亡率为3%。左冠状动脉前降支近端的二元再狭窄率为4.1%。无靶血管再次血管重建的生存率为94%。未观察到晚期支架血栓形成病例。
在左冠状动脉前降支近端植入药物洗脱支架进行经皮血管重建在短期和长期内都是一种安全且非常有效的治疗策略。
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