Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
JACC Cardiovasc Interv. 2010 Jun;3(6):584-94. doi: 10.1016/j.jcin.2010.03.017.
We investigated the long-term clinical outcomes and independent predictors of major cardiac events in unprotected left main coronary artery disease (ULMCA) patients treated by percutaneous coronary intervention with drug-eluting stent (DES).
There is limited information on long-term (>3 years) outcomes after DES implantation for ULMCA. Furthermore, bifurcation angle and SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score are emerging as parameters for patient risk stratification, and their prognostic implications have still to be elucidated.
One hundred forty-eight patients with ULMCA treated with DES were analyzed and compared with a historical cohort of 79 patients who received bare-metal stents for the treatment of ULMCA. Patient-oriented composite end point was defined as the occurrence of all-cause death, any myocardial infarction, or any revascularization.
The 4-year cumulative incidence of all-cause death, any myocardial infarction, any revascularization, and patient-oriented composite were 35.6%, 3.8%, 25.2%, and 54.4%, respectively. These end points had relatively increased from 1 year to 4 years by Delta70%, Delta5%, Delta50%, and Delta68%, respectively. When compared with a historical cohort who received bare-metal stents for ULMCA treatment, landmark analysis performed after the first 2 years of follow-up demonstrated that the DES cohort had significantly higher patient-oriented composite end point over the last 2 years of follow-up (26% vs. 8%, p = 0.02). EuroSCORE (European System for Cardiac Operative Risk Evaluation), cardiogenic shock, and SYNTAX score were identified as independent predictors for the 4-year patient-oriented composite, whereas bifurcation angle was not.
Late increase in patient-oriented composite end points after DES implantation for ULMCA warrants careful and long-term follow-up. SYNTAX score and EuroSCORE appear to have a significant prognostic value in long-term patient risk.
我们研究了经皮冠状动脉介入治疗药物洗脱支架（DES）治疗无保护左主干冠状动脉疾病（ULMCA）患者的长期临床结果和主要心脏事件的独立预测因素。
DES 植入治疗 ULMCA 后长期（>3 年）结果的信息有限。此外，分叉角和 SYNTAX（经皮冠状动脉介入治疗与心脏手术的协同作用）评分作为患者风险分层的参数出现，但其预后意义仍有待阐明。
分析了 148 例经 DES 治疗的 ULMCA 患者，并与 79 例接受裸金属支架治疗 ULMCA 的历史队列进行比较。以患者为中心的复合终点定义为全因死亡、任何心肌梗死或任何血运重建的发生。
4 年全因死亡、任何心肌梗死、任何血运重建和以患者为中心的复合终点的累积发生率分别为 35.6%、3.8%、25.2%和 54.4%。这些终点从 1 年到 4 年分别增加了 70%、5%、50%和 68%。与接受裸金属支架治疗 ULMCA 的历史队列相比，在随访的前 2 年进行的里程碑分析显示，DES 队列在随访的最后 2 年的以患者为中心的复合终点显著更高（26%比 8%，p=0.02）。EuroSCORE（欧洲心脏手术风险评估系统）、心源性休克和 SYNTAX 评分被确定为 4 年以患者为中心的复合的独立预测因素，而分叉角不是。
DES 植入治疗 ULMCA 后以患者为中心的复合终点的晚期增加需要仔细和长期随访。SYNTAX 评分和 EuroSCORE 在长期患者风险中具有显著的预后价值。
