Freeman Melanie, Clark David J, Andrianopoulos Nick, Duffy Stephen J, Lim Han S, Brennan Angela, Charter Kerrie, Shaw James, Horrigan Mark, Ajani Andrew E, Sebastian Martin, Reid Christopher M, Farouque H M Omar
Department of Cardiology, Austin Hospital, Melbourne, Victoria, Australia.
Catheter Cardiovasc Interv. 2009 May 1;73(6):763-8. doi: 10.1002/ccd.21941.
Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practice.
The study population comprised 1,713 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex, and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004-December 2006). We compared the in-hospital, 30-day, and 1-year outcomes of the 109 patients undergoing PCI for ostial, with the 1,604 patients with proximal nonostial lesions. Left main and bifurcation lesions were excluded.
Patients in the ostial group were older (mean age 68.8 +/- 11 vs. 64.9 +/- 12 years; P = 0.001), and there was a greater proportion of women (38.5% vs. 28.0%; P = 0.021). Other clinical characteristics were similar. The nonostial group were more likely receive a stent (94.6% vs. 87.2%; P = 0.005) but drug-eluting stents (DES) were deployed more often in the ostial group (47.9% vs. 66.1%; P < 0.0001). There was lower procedural success, with no significant difference in in-hospital death, bleeding or emergency PCI, but unplanned in-hospital coronary artery bypass grafting was more frequent in the ostial group (4.8% vs. 1.0%; P = 0.007). There was no difference in 30-day major adverse cardiac events. However, 12-month death (8.8% vs. 4%, log rank P = 0.032) and MACE (24.2% vs. 13.8%, log rank P = 0.005) were higher in the ostial group than the nonostial group with trends to increased incidence of myocardial infarction (6.6% vs. 4.7%, P = NS), and target vessel revascularization (13.2% vs. 7.9%, P = NS).
In contemporary, Australian interventional practice, PCI for ostial lesions is associated with a high incidence of adverse outcome at one year despite the introduction of DES.
开口处病变是经皮冠状动脉介入治疗（PCI）后预后欠佳的一个棘手亚组。本研究旨在分析当代澳大利亚介入治疗实践中开口处病变的预后情况。
研究人群包括1713例连续接受PCI治疗左前降支、左旋支和右冠状动脉近端病变的患者，这些患者前瞻性纳入墨尔本介入治疗组注册研究（2004年2月至2006年12月）。我们比较了109例接受开口处PCI治疗患者与1604例近端非开口处病变患者的住院期间、30天和1年的预后情况。排除左主干和分叉病变。
开口处病变组患者年龄更大（平均年龄68.8±11岁对64.9±12岁；P = 0.001），女性比例更高（38.5%对28.0%；P = 0.021）。其他临床特征相似。非开口处病变组更可能接受支架治疗（94.6%对87.2%；P = 0.005），但开口处病变组更常使用药物洗脱支架（DES）（47.9%对66.1%；P < 0.0001）。手术成功率较低，住院期间死亡、出血或急诊PCI无显著差异，但开口处病变组非计划住院冠状动脉旁路移植术更频繁（4.8%对1.0%；P = 0.007）。30天主要不良心脏事件无差异。然而，开口处病变组12个月死亡率（8.8%对4%，对数秩检验P = 0.032）和主要不良心血管事件（MACE）（24.2%对13.8%，对数秩检验P = 0.005）高于非开口处病变组，心肌梗死发生率有增加趋势（6.6%对4.7%，P = 无统计学意义），靶血管血运重建率也有增加趋势（13.2%对7.9%，P = 无统计学意义）。
在当代澳大利亚介入治疗实践中，尽管引入了DES，但开口处病变的PCI治疗在1年时不良预后发生率仍较高。
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