S. Giovanni Battista "Molinette" Hospital, University of Turin, Italy.
Clin Res Cardiol. 2010 Apr;99(4):235-42. doi: 10.1007/s00392-009-0112-3. Epub 2010 Jan 3.
Most cardiologists performing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main disease (ULM) mandate mid-term angiographic follow-up, yet there are few data supporting this approach. We aimed to retrospectively compare the outcome of patients with ULM treated with DES according to their follow-up management strategy.
Patients with ULM stenosis undergoing PCI with DES and surviving up to 6 months were retrospectively identified from our ongoing database. We distinguished those undergoing clinical follow-up only, those with clinically driven angiographic follow-up, and those with routine angiographic follow-up. The primary end-point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, bypass surgery, or repeat ULM PCI).
A total of 198 patients were included: 55 (28%) in the clinical follow-up group, 64 (32%) in the clinically driven angiographic follow-up group, and 79 (40%) in the routine angiographic follow-up group. After 37.0 +/- 15.7 months, mortality was similar in the 3 groups (respectively 7.3, 4.7, and 5.9%, p = 0.27). However, MACE were significantly more common in the clinically driven angiographic follow-up group (42.2 vs. 7.3 and 26.1%, p = 0.02), mainly due to the expected increase in repeat revascularization in those undergoing angiographic follow-up (23.4 vs. 1.8 and 13.14%). Notably, there were no differences in the rate of stent thrombosis across the three groups, with rates of 3.1 vs. 1.8 and 2.5% (p = 0.35).
An expectant management can be safely adopted in most patients with ULM treated percutaneously, as long as a low threshold for control coronary angiography is maintained.
大多数行药物洗脱支架（DES）经皮冠状动脉介入治疗（PCI）治疗无保护左主干疾病（ULM）的心脏病专家要求进行中期血管造影随访，但支持这种方法的数据很少。我们旨在根据患者的随访管理策略，回顾性比较接受 DES 治疗的 ULM 患者的结局。
从我们正在进行的数据库中回顾性确定了接受 DES 经皮 PCI 治疗并存活至 6 个月以上的 ULM 狭窄患者。我们区分了仅接受临床随访、仅进行临床驱动的血管造影随访以及进行常规血管造影随访的患者。主要终点是长期主要不良心脏事件（MACE，即死亡、心肌梗死、旁路手术或再次 ULM PCI）的发生率。
共纳入 198 例患者：55 例（28%）在临床随访组，64 例（32%）在临床驱动的血管造影随访组，79 例（40%）在常规血管造影随访组。随访 37.0 ± 15.7 个月后，3 组死亡率相似（分别为 7.3%、4.7%和 5.9%，p = 0.27）。然而，临床驱动的血管造影随访组的 MACE 发生率明显更高（42.2%比 7.3%和 26.1%，p = 0.02），主要是由于接受血管造影随访的患者再次血运重建的预期增加（23.4%比 1.8%和 13.14%）。值得注意的是，3 组支架血栓形成率无差异，分别为 3.1%、1.8%和 2.5%（p = 0.35）。
只要保持较低的冠状动脉造影控制阈值，大多数接受经皮治疗的 ULM 患者可以安全采用期待治疗策略。
