Kim Young-Hak, Dangas George D, Solinas Emilia, Aoki Jiro, Parise Helen, Kimura Masashi, Franklin-Bond Theresa, Dasgupta Neil K, Kirtane Ajay J, Moussa Issam, Lansky Alexandra J, Collins Michael, Stone Gregg W, Leon Martin B, Moses Jeffrey W, Mehran Roxana
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York, USA.
Am J Cardiol. 2008 Mar 15;101(6):801-6. doi: 10.1016/j.amjcard.2007.10.052. Epub 2008 Jan 18.
This study was aimed to evaluate outcomes of patients with unprotected left main coronary artery (LMCA) stenosis who were treated with drug-eluting stents. Sixty-three consecutive patients with unprotected LMCA stenosis were treated with sirolimus-eluting stents in 52 (83%) patients and paclitaxel-eluting stents in 11 (17%) patients, in whom percutaneous intervention was considered the sole alternative because of high surgical risk and/or patient preference. Urgent percutaneous coronary intervention within 24 hours after angiography was performed in 6 (10%) patients. The patients were predominantly at high surgical risk with 35 (56%) having EuroSCORE >6 and 39 (62%) having Parsonnet score >15. Involvement of the distal LMCA was observed in 46 (73%) patients. Procedural success was achieved in all patients. Intravascular ultrasound was used in 51 (81%) patients. Single-stenting strategy was adopted in 36 (78%) patients with bifurcation stenosis. There were no death, Q-wave myocardial infarction, stent thrombosis, or urgent repeat revascularization events during hospitalization. Over a mean follow-up of 11.7 +/- 7.7 months, 18 (29%) patients experienced major adverse cardiac events, including 3 (5%) deaths, 7 (11%) myocardial infarctions, and 10 (16%) target lesion revascularizations. Stent thrombosis developed in 1 (0.6%) patient at 35 days after the procedure. Bifurcation involvement was an independent predictor of major adverse cardiac events by multivariate analysis (hazard ratio 12.90, 95% confidence interval 1.36 to 122.45, p = 0.0259). In conclusion, drug-eluting stent placement for unprotected LMCA stenosis may be a feasible therapeutic alternative in patients at high surgical risk. However, bifurcation stenosis remains a significant predictor of unfavorable clinical outcome.
本研究旨在评估接受药物洗脱支架治疗的无保护左主干冠状动脉（LMCA）狭窄患者的预后。连续63例无保护LMCA狭窄患者接受了治疗，其中52例（83%）植入西罗莫司洗脱支架，11例（17%）植入紫杉醇洗脱支架，由于手术风险高和/或患者偏好，经皮介入被认为是唯一的选择。6例（10%）患者在血管造影后24小时内接受了紧急经皮冠状动脉介入治疗。患者主要为高手术风险，35例（56%）欧洲心脏手术风险评估系统（EuroSCORE）>6，39例（62%）Parsonnet评分>15。46例（73%）患者观察到左主干远端受累。所有患者均获得手术成功。51例（81%）患者使用了血管内超声。36例（78%）分叉病变狭窄患者采用了单支架策略。住院期间无死亡、Q波心肌梗死、支架血栓形成或紧急重复血管重建事件。平均随访11.7±7.7个月，18例（29%）患者发生主要不良心脏事件，包括3例（5%）死亡、7例（11%）心肌梗死和10例（16%）靶病变血管重建。1例（0.6%）患者在术后35天发生支架血栓形成。多因素分析显示，分叉病变是主要不良心脏事件的独立预测因素（风险比12.90，95%置信区间1.36至122.45，P=0.0259）。总之，对于手术风险高的无保护LMCA狭窄患者，植入药物洗脱支架可能是一种可行的治疗选择。然而，分叉病变狭窄仍然是不良临床结局的重要预测因素。
