Pavei Andrea, Oreglia Jacopo A, Martin Guillaume, Tousek Petr, Sharif Faisal, Farah Bruno, Sauguet Antoine, Fajadet Jean
Clinique Pasteur, Toulouse, France.
EuroIntervention. 2009 Jan;4(4):457-63. doi: 10.4244/eijv4i4a79.
To evaluate the long-term follow-up of drug-eluting stents (DES) in the treatment of unprotected left main coronary artery (ULMCA).
One hundred and forty-eight patients (mean age 71 +/- 10 years) with ULMCA stenoses underwent percutaneous coronary intervention (PCI) with DES. Mean ejection fraction (EF) was 63 +/- 13% and distal ULMCA was involved in 63.5% of cases. In-hospital outcome showed one intra-procedural death, no stent thrombosis and 2% non Q-wave myocardial infarction (MI). Clinical follow-up was available in all patients (874 +/- 382 days): 10.1% of them had died, 8.8% had target lesion revascularisation (TLR) and 4.1% experienced MI. Major adverse cardiac events (MACE) occurred in 20.3%. Mortality predictors were EF < or = 55% (OR 3.6, 95%-C.I. 1.3-10.1, p = 0.016) and EuroSCORE > or = 6 (OR 3.9, 95%-CI 1.1-14.1, p = 0.037). TLR predictors were distal lesion (OR 8.5, 95%-CI 1.1-15, p = 0.041) and age < 64 years (OR 3.1, 95%-CI 1-9, p = 0.042). MACE predictor was EF < or = 55% (OR 2.4, 95%-CI 1.1-5.2, p = 0.027).
ULMCA stenting with DES is safe, with favourable in-hospital outcome. Long-term results are acceptable with a mortality rate of 10%, a TLR rate of 9%, and a MACE rate of 20%. Low EF and high EuroSCORE predict mortality, while younger age and distal lesions predict TLR. Low EF also predicts MACE.
评估药物洗脱支架（DES）治疗无保护左主干冠状动脉（ULMCA）的长期随访结果。
148例（平均年龄71±10岁）ULMCA狭窄患者接受了DES经皮冠状动脉介入治疗（PCI）。平均射血分数（EF）为63±13%，63.5%的病例累及ULMCA远端。住院期间结果显示1例术中死亡，无支架血栓形成，2%发生非Q波心肌梗死（MI）。所有患者均获得临床随访（874±382天）：10.1%的患者死亡，8.8%发生靶病变血管重建（TLR），4.1%发生MI。主要不良心脏事件（MACE）发生率为20.3%。死亡率的预测因素为EF≤55%（比值比3.6，95%可信区间1.3 - 10.1，p = 0.016）和欧洲心脏手术风险评估系统（EuroSCORE）≥6（比值比3.9，95%可信区间1.1 - 14.1，p = 0.037）。TLR的预测因素为远端病变（比值比8.5，95%可信区间1.1 - 15，p = 0.041）和年龄<64岁（比值比3.1，95%可信区间1 - 9，p = 0.042）。MACE的预测因素为EF≤55%（比值比2.4，95%可信区间1.1 - 5.2，p = 0.027）。
DES置入治疗ULMCA是安全的，住院期间结果良好。长期结果可以接受，死亡率为10%，TLR率为9%，MACE率为20%。低EF和高EuroSCORE预测死亡率，而年轻和远端病变预测TLR。低EF也预测MACE。
