裸金属支架或药物洗脱支架内再狭窄的无保护左主干病变治疗后的临床转归。

Clinical outcome after management of unprotected left main in-stent restenosis after bare metal or drug-eluting stents.

机构信息

Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China.

出版信息

Chin Med J (Engl). 2010 Apr 5;123(7):794-9.

PMID:20497666

Abstract

BACKGROUND

Implantation of either bare metal stent (BMS) or drug-eluting stent (DES) has been used in every day practice for patients with unprotected left main stenosis (UPLMS). There are still a lack of data regarding the subsequent results of UPLMS in-stent restenosis (ISR). The present study aimed at determining the clinical outcome of UPLMS ISR patients after implantation of either BMS or DES.

METHODS

Patients with UPLMS ISR after stenting were included. The primary endpoint was the cumulative major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).

RESULTS

UPLMS ISR rate was 14.8% (n = 73, 15.7% after BMS, 14.5% for DES) after average of (3.89 +/- 2.01) years (range from 1 to 10.5 years) follow-up. Angiographic follow-up between 6 - 8 months was available in 85.3%. Of these, repeat percutaneous coronary intervention (PCI) was used in 62 (84.9%) patients, with medicine only in 9 (12.4%) and coronary artery bypass graft (CABG) in 2 (2.7%). Most repeat PCI patients were with unstable angina (87.0%), and had decreased left ventricular ejection fraction ((42.58 +/- 5.12)%), fewer focal/ostial left circumflex branch (LCX) lesions, in relative to medicine only group. After (31.9 +/- 23.3) months, the MACE, MI, TVR and cardiac death were 31.5%, 1.4%, 24.1% and 8.2%, respectively. Definite and possible stent thrombosis occurred in 1 (1.4%) patient.

CONCLUSIONS

Medical therapy for asymptomatic isolated ostial LCX was safe. Repeat PCI for UPLMS ISR was associated with acceptable early and short-term clinical outcome. Further study was needed to elucidate the role of CABG in treating UPLMS ISR.

摘要

背景

裸金属支架（BMS）或药物洗脱支架（DES）的植入已在日常实践中用于治疗无保护左主干狭窄（UPLMS）患者。对于 UPLMS 支架内再狭窄（ISR）患者的后续结果，仍然缺乏相关数据。本研究旨在确定 UPLMS ISR 患者在植入 BMS 或 DES 后的临床结果。

方法

纳入 UPLMS ISR 支架术后患者。主要终点是累积主要不良心脏事件（MACE），包括心脏死亡、心肌梗死（MI）和靶血管血运重建（TVR）。

结果

平均（3.89+/-2.01）年（范围为 1 至 10.5 年）随访后，UPLMS ISR 发生率为 14.8%（n=73，BMS 后为 15.7%，DES 后为 14.5%）。6-8 个月的血管造影随访可用于 85.3%的患者。其中，62 例（84.9%）患者再次行经皮冠状动脉介入治疗（PCI），9 例（12.4%）患者仅接受药物治疗，2 例（2.7%）患者接受冠状动脉旁路移植术（CABG）。大多数再次接受 PCI 的患者均有不稳定型心绞痛（87.0%），且左心室射血分数（42.58+/-5.12）%较低，与仅接受药物治疗的患者相比，局限性/开口回旋支（LCX）病变较少。（31.9+/-23.3）个月后，MACE、MI、TVR 和心脏死亡的发生率分别为 31.5%、1.4%、24.1%和 8.2%。1 例（1.4%）患者发生明确和可能的支架血栓形成。