Hertting Klaus, Härle Tobias, Krause Korff, Reimers Jacobus, Boczor Sigrid, Kuck Karl-Heinz
Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany.
Exp Clin Cardiol. 2008 Spring;13(1):37-41.
To elucidate the influence of drug-eluting stents (DESs) on interventional therapy of de novo unprotected left main stem (LMS) lesions in a hospital with on-site cardiac surgery.
A retrospective study of all patients with unprotected LMS angioplasty from 1999 to 2005 was conducted with regard to clinical and procedural data, and follow-up data. Fifty-four patients with unprotected LMS stenosis were treated inter-ventionally. Of these patients, 16 were treated with DESs. Seven patients presented with cardiogenic shock. During their hospital stay, four patients died (all treated with bare metal stents [BMSs], three initially presenting with cardiogenic shock). Follow-up data for 53 patients (98%) were obtained. Median follow-up time was 24 months (25th percentile, 12 months; 75th percentile, 35 months). Survival after nine months was 87% (81% from the BMS-treated group, and 100% from the DES-treated group). Control angiography had been performed in 36 patients (67%). Patients with unprotected LMS with an angiographic follow-up had a higher nine-month survival rate than patients without (36 of 36 patients [100%] versus 10 of 17 patients [59%], respectively; P<0.0001). Target lesion revascularization rate was 19% in both the BMS and the DES groups. Methods of revascularization did not vary significantly between the groups.
In the present study of selected patients with LMS stenosis, the use of DESs showed a low mortality rate but did not have a clear effect on target lesion revascularization rate compared with BMSs. A close follow-up appears to be mandatory to achieve acceptable results.
阐明药物洗脱支架（DES）对一家具备现场心脏手术条件的医院中初发无保护左主干（LMS）病变介入治疗的影响。
对1999年至2005年期间所有接受无保护LMS血管成形术的患者进行回顾性研究，收集临床和手术数据以及随访数据。54例无保护LMS狭窄患者接受了介入治疗。其中16例患者使用了DES。7例患者出现心源性休克。在住院期间，4例患者死亡（均接受裸金属支架[BMS]治疗，3例最初表现为心源性休克）。获得了53例患者（98%）的随访数据。中位随访时间为24个月（第25百分位数为12个月；第75百分位数为35个月）。9个月时的生存率为87%（BMS治疗组为81%，DES治疗组为100%）。36例患者（67%）进行了对照血管造影。接受血管造影随访的无保护LMS患者9个月生存率高于未接受随访的患者（分别为36例中的36例[100%]和17例中的10例[59%]；P<0.0001）。BMS组和DES组的靶病变血运重建率均为19%。两组之间血运重建方法差异无统计学意义。
在本项对选定的LMS狭窄患者的研究中，与BMS相比，DES的使用显示出较低的死亡率，但对靶病变血运重建率没有明显影响。为获得可接受的结果，密切随访似乎是必要的。
