Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Am Coll Cardiol. 2011 Mar 22;57(12):1349-58. doi: 10.1016/j.jacc.2010.10.041.
The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (LMCA) disease.
Few data on the clinical course and management of patients experiencing restenosis after DES treatment for unprotected LMCA disease have appeared.
Between February 2003 and November 2007, 509 consecutive patients with unprotected LMCA disease underwent DES implantation, with 402 (80.1%) undergoing routine surveillance or clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization.
The overall incidence of angiographic ISR in LMCA lesions was 17.6% (71 of 402 patients, 57 with focal-type and 14 with diffuse-type ISR. Forty patients (56.3%) underwent repeated PCI, 10 (14.1%) underwent bypass surgery, and 21 (29.6%) were treated medically. During long-term follow-up (a median of 31.7 months), there were no deaths, 1 (2.2%) MI, and 6 (9.5%) repeated target-lesion revascularization cases. The incidence of major adverse cardiac event was 14.4% in the medical group, 13.6% in the repeated PCI group, and 10.0% in the bypass surgery group (p = 0.91). Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI.
The incidence of ISR was 17.7% after DES stenting for LMCA. The long-term clinical prognosis of patients with DES-ISR associated with LMCA stenting might be benign, given that these patients were optimally treated with the clinical judgment of the treating physician.
本研究旨在评估经皮冠状动脉介入治疗（PCI）药物洗脱支架（DES）治疗无保护左主干冠状动脉（LMCA）疾病后发生支架内再狭窄（ISR）的发生率、预测因素和长期预后。
关于 DES 治疗无保护 LMCA 疾病后发生再狭窄患者的临床过程和处理方法的数据很少。
2003 年 2 月至 2007 年 11 月，509 例连续无保护 LMCA 疾病患者接受 DES 植入术，其中 402 例（80.1%）接受常规监测或临床驱动的血管造影随访。主要不良心脏事件定义为死亡、心肌梗死（MI）或靶病变血运重建的复合事件。
LMCA 病变的血管造影 ISR 总体发生率为 17.6%（402 例患者中的 71 例，57 例为局灶型，14 例为弥漫型 ISR。40 例（56.3%）患者接受了再次 PCI，10 例（14.1%）患者接受了旁路手术，21 例（29.6%）患者接受了药物治疗。在长期随访（中位数 31.7 个月）中，无死亡、1 例（2.2%）MI 和 6 例（9.5%）靶病变血运重建病例。药物治疗组、再次 PCI 组和旁路手术组的主要不良心脏事件发生率分别为 14.4%、13.6%和 10.0%（p = 0.91）。多因素分析显示，DES-ISR 的发生并不影响死亡或 MI 的风险。
DES 支架置入治疗 LMCA 后 ISR 的发生率为 17.7%。DES 支架治疗 LMCA 相关 ISR 的患者长期临床预后可能良好，因为这些患者经治疗医生的临床判断得到了最佳治疗。
