无保护左主干冠状动脉支架置入术的临床结果

Clinical results of unprotected left main coronary stenting.

作者信息

Ben-Dor Itsik, Vaknin-Assa Hana, Lev Eli, Brosh David, Fuchs Shmuel, Assali Abid, Kornowski Ran

机构信息

Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.

出版信息

Isr Med Assoc J. 2009 Mar;11(3):154-9.

PMID:19544705

Abstract

BACKGROUND

Although unprotected left main coronary artery disease is considered by contemporary guidelines to be an indication for surgery, percutaneous coronary intervention may be necessary in patients at high surgical risk.

OBJECTIVES

To assess the outcome of angioplasty in the treatment of unprotected LMCA disease.

METHODS

Angiographic and clinical data were collected prospectively for all patients who underwent emergent or nonemergent (planned) therapeutic PCI for unprotected LMCA disease at our center from 2003 to 2007. Baseline values were compared with findings at 1, 6 and 12 months after the procedure.

RESULTS

The study group comprised 71 consecutive patients with a mean age of 74 +/- 12 years; 63% were men, and 31% had diabetes. Forty-three patients had a planned procedure and 28 an emergent procedure. Mean EuroScore was 7.3 +/- 3.6 (range 5-12). Forty-nine percent of the procedures were performed with bare metal stents and 51% with drug-eluting stents. Procedural success was achieved in 100% of cases. The overall mortality rate was 11.3% at 1 month, 18.3% at 6 months and 19.7% at 12 months. Elective PCI was associated with significantly lower mortality (2.3% vs. 25% at 1 month, 4.6% vs. 39% at 6 months and 6.9% vs. 39% at 12 months), and the use of drug-eluting stents was associated with lower rates of target vessel revascularization and major adverse cardiac events than use of bare metal stents (2.8% vs. 14% at 1 month, 8.3% vs. 43% at 6 and 12 months). Variables that correlated with increased mortality or MACE at 6 and 12 months were cardiogenic shock, emergent PCI, ejection fraction < 35%, renal failure, distal left main stenosis location, and reference diameter < 3 mm.

CONCLUSIONS

PCI is a feasible and relatively safe therapeutic option for unprotected LMCA. The less favorable outcome of emergent compared to planned PCI is probably attributable to the overwhelming acute myocardial ischemic injury in emergent cases. The use of drug-eluting stents may improve the intermediate-term restenosis rate.

摘要

背景

尽管当代指南认为无保护左主干冠状动脉疾病是手术指征，但对于手术风险高的患者，经皮冠状动脉介入治疗可能是必要的。

目的

评估血管成形术治疗无保护左主干冠状动脉疾病的疗效。

方法

前瞻性收集2003年至2007年在本中心因无保护左主干冠状动脉疾病接受急诊或非急诊（计划性）治疗性经皮冠状动脉介入治疗（PCI）的所有患者的血管造影和临床数据。将基线值与术后1、6和12个月的检查结果进行比较。

结果

研究组包括71例连续患者，平均年龄74±12岁；63%为男性，31%患有糖尿病。43例患者接受计划性手术，28例接受急诊手术。平均欧洲心脏手术风险评估系统（EuroScore）评分为7.3±3.6（范围5 - 12）。49%的手术使用裸金属支架，51%使用药物洗脱支架。所有病例手术成功率均达到100%。1个月时总死亡率为11.3%，6个月时为18.3%，12个月时为19.7%。择期PCI的死亡率显著较低（1个月时为2.3%对25%，6个月时为4.6%对39%，12个月时为6.9%对39%），与使用裸金属支架相比，使用药物洗脱支架的靶血管再血管化率和主要不良心脏事件发生率较低（1个月时为2.8%对14%，6个月和12个月时为8.3%对43%）。与6个月和12个月时死亡率或主要不良心血管事件增加相关的变量有心源性休克、急诊PCI、射血分数<35%、肾衰竭、左主干远端狭窄部位以及参考直径<3 mm。