Department of Cardiology, Odense University Hospital, Odense, Denmark.
Catheter Cardiovasc Interv. 2010 Jan 1;75(1):101-8. doi: 10.1002/ccd.22205.
We examined mortality, risk of myocardial infarction (MI), and target lesion revascularization (TLR) in high-risk patients with unprotected left main (LM) percutaneous coronary intervention (PCI) in Western Denmark.
PCI of left main coronary artery lesions may be an alternative to coronary artery bypass grafting in high-risk surgical patients.
From January 2005 to May 2007, all patients who had unprotected LM PCI with stent implantation were identified in the Western Denmark Heart Registry. The indications for PCI were: (1) ST segment elevation MI (STEMI), (2) non-STEMI (NSTEMI) or unstable angina, and (3) stable angina. All patients were followed up for 18 months.
A total of 344 patients were treated with LM PCI (STEMI: 71, NSTEMI/unstable angina: 157, and stable angina: 116). In STEMI patients, the median logistic EuroSCORE was 22.5 (interquartile range 12.5-39.5), in non-STEMI (NSTEMI)/unstable angina patients 13.8 (4.8-23.9), and in stable angina patients 4.8 (2.2-10.4). Mortality after 18 months 38.0, 18.5, and 11.2% (P < 0.001) in patients with STEMI, NSTEMI/unstable angina, and stable angina, respectively. MI after 18 months was 9.9, 6.4, and 6.0% (P = ns), respectively. Four subacute and one late definite stent thrombosis were seen. TLR occurred in 5.6, 4.5, and 6.9% (P = ns) of patients, respectively.
After PCI, patients with STEMI and LM culprit lesion have a high-mortality risk, whereas long-term outcome for patients with NSTEMI and stable angina pectoris is comparable with other high surgical risk patients with unprotected left main lesion. Further, TLR rates and risk of stent thrombosis were low.
我们研究了丹麦西部高危无保护左主干（LM）经皮冠状动脉介入治疗（PCI）患者的死亡率、心肌梗死（MI）风险和靶病变血运重建（TLR）。
左主干冠状动脉病变的 PCI 可能是高危手术患者冠状动脉旁路移植术的替代方法。
2005 年 1 月至 2007 年 5 月，在丹麦西部心脏注册中心确定了所有接受无保护 LM PCI 加支架植入的患者。PCI 的适应证为：（1）ST 段抬高型心肌梗死（STEMI）；（2）非 ST 段抬高型心肌梗死（NSTEMI）或不稳定型心绞痛；（3）稳定型心绞痛。所有患者均随访 18 个月。
共 344 例患者接受 LM PCI 治疗（STEMI：71 例，NSTEMI/不稳定型心绞痛：157 例，稳定型心绞痛：116 例）。STEMI 患者的中位数 logistic EuroSCORE 为 22.5（四分位间距 12.5-39.5），NSTEMI/不稳定型心绞痛患者为 13.8（4.8-23.9），稳定型心绞痛患者为 4.8（2.2-10.4）。18 个月后死亡率分别为 STEMI、NSTEMI/不稳定型心绞痛和稳定型心绞痛患者的 38.0%、18.5%和 11.2%（P<0.001）。18 个月后 MI 分别为 9.9%、6.4%和 6.0%（P=ns）。有 4 例亚急性和 1 例晚期明确支架血栓形成。TLR 分别发生在 5.6%、4.5%和 6.9%（P=ns）的患者中。
PCI 后，STEMI 患者和 LM 罪犯病变死亡率高，而 NSTEMI 患者和稳定型心绞痛患者的长期预后与其他高危、无保护左主干病变患者相似。此外，TLR 发生率和支架血栓形成风险较低。
