Gao Run-lin, Xu Bo, Chen Ji-lin, Yang Yue-jin, Qiao Shu-bin, Li Jian-jun, Qin Xue-wen, Yao Min, Liu Hai-bo, Wu Yong-jian, Yuan Jin-qing, Chen Jue
Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical, College, Beijing, China.
Am Heart J. 2008 Mar;155(3):553-61. doi: 10.1016/j.ahj.2007.10.030.
The efficacy and safety of drug-eluting stent (DES) implantation for unprotected left main coronary artery (LMCA) disease remain to be established in different clinical settings.
Elective DES implantation for unprotected LMCA stenosis was performed in 220 patients at the Fu Wai Hospital, China, from April 2003 to February 2006. Data derived from the latter group were compared with those derived from 224 patients treated with bare-metal stents (BMSs) before March 2003 in a Chinese registry of unprotected LMCA stenting.
Compared with the historical BMS control group, the DES group had more multivessel disease and underwent more bifurcation stenting. The inhospital major adverse cardiac events were significantly higher in the DES than in the BMS recipients (4.1% vs 0.9%, P = .030) because of more complex lesions and procedures in the DES group. During the 15-month mean follow-up period, cumulative cardiac death (0.5% vs 4.9%, P = .004), target-vessel revascularization (5.9% vs 11.6%, P = .034), and major adverse cardiac event (9.5% vs 16.5%, P = .029) rates were significantly lower in the DES than in the BMS group. There was no significant difference in clinical efficacy between sirolimus- and paclitaxel-eluting stents. Angiographic follow-up was performed in 46.4% of DES and 45.7% of BMS recipients, respectively; and the binary restenosis rate was significantly lower in the DES versus the BMS control group (16.7% vs 31.4%, P = .014).
Based on this comparison with a historical control, DES implantation for unprotected LMCA appears safe in selected patients and might be more effective in preventing major adverse cardiac events compared with BMS implantation over a mean follow-up period of 15 months.
药物洗脱支架（DES）植入治疗无保护左主干冠状动脉（LMCA）疾病的疗效和安全性在不同临床环境中仍有待确定。
2003年4月至2006年2月期间，中国阜外医院对220例无保护LMCA狭窄患者进行了择期DES植入。将后一组的数据与2003年3月之前在中国无保护LMCA支架置入登记处接受裸金属支架（BMS）治疗的224例患者的数据进行比较。
与历史BMS对照组相比，DES组多支血管病变更多，且接受分叉支架置入术更多。由于DES组病变和操作更复杂，DES组住院期间主要不良心脏事件显著高于BMS接受者（4.1%对0.9%，P = 0.030）。在平均15个月的随访期内，DES组累积心脏死亡（0.5%对4.9%，P = 0.004）、靶血管血运重建（5.9%对11.6%，P = 0.034）和主要不良心脏事件（9.5%对16.5%，P = 0.029）发生率显著低于BMS组。西罗莫司洗脱支架和紫杉醇洗脱支架的临床疗效无显著差异。分别对46.4%的DES接受者和45.7%的BMS接受者进行了血管造影随访；DES组的二元再狭窄率显著低于BMS对照组（16.7%对31.4%，P = 0.014）。
基于与历史对照的比较，在选定患者中，无保护LMCA的DES植入似乎是安全的，并且在平均15个月的随访期内，与BMS植入相比，可能在预防主要不良心脏事件方面更有效。
