Department of Interventional Cardiology, Henry Dunant Hospital, Athens, Greece.
Cardiol J. 2011;18(2):165-70.
Most available data indicates that stenting for unprotected left main coronary artery disease (ULMCA) with drug-eluting stents (DES) is safe and effective. At present, surgery is considered the gold standard for optimal revascularization. The aim of this study was to evaluate the immediate and long term outcome of patients with ULMCA stenosis who underwent percutaneous coronary intervention (PCI) with DES implantation in a single center.
Coronary stents were implanted into ULMCA in 72 patients. Patients with a de novo ≥ 50% diameter stenosis, or ≤ 4.0 mm(2) on intravascular ultrasound measurement of left main coronary artery were treated using 1.6 ± 1.2 DES per patient. ULM stenting was performed when coronary artery bypass grafting was considered at high surgical risk (mean EuroSCORE 7.1) and/or surgery was refused despite their physician's recommendation. Patients enrolled in the study underwent clinical evaluation one, six and 12 months after the procedure, and then annually. Coronary angiography was routinely performed at nine to 12 months from the index procedure and/or was clinically driven at any time. Acute and long term main adverse cardiac events (MACE) were assessed: cardiac death, myocardial infarction and additional target lesion or non-target lesion revascularization (TLR).
Angiographic and clinical success of PCI was 100%. Complete revascularization was performed in all patients. Mean follow-up duration was 2.5 years ± 10 months with 3% mortality in the first 12 months and total MACEs in 30.6%. During follow-up, death occurred in four (5.5%) patients. Angiographic follow-up was performed in 59 (82%) patients and TLR occurred in 18.05% of treated lesions. One possible stent thrombosis was documented.
Considering the high surgical risk present in most of our patients, ULM stenting is feasible and safe with excellent immediate and mid-term results. Long term results seem to be encouraging, showing limited mortality and the total absence of definite or probable thrombosis.
大多数现有数据表明，经皮冠状动脉介入治疗（PCI）联合药物洗脱支架（DES）治疗无保护左主干冠状动脉疾病（ULMCA）是安全有效的。目前，手术被认为是最佳血运重建的金标准。本研究旨在评估单中心接受 DES 植入治疗 ULMCA 狭窄患者的即刻和长期结果。
72 例患者的 ULMCA 植入了冠状动脉支架。对新发病变左主干直径狭窄≥50%或血管内超声测量左主干冠状动脉狭窄≤4.0mm²的患者，每例患者植入 1.6±1.2 个 DES。当冠状动脉旁路移植术被认为具有高手术风险（平均欧洲心脏手术风险评分 7.1）和/或尽管患者的医生建议，但患者拒绝手术时，进行 ULM 支架置入。患者在术后 1、6 和 12 个月以及此后每年进行临床评估。常规在指数手术后 9-12 个月进行冠状动脉造影检查，或在任何时候根据临床情况进行检查。评估急性和长期主要不良心脏事件（MACE）：心脏死亡、心肌梗死和额外的靶病变或非靶病变血运重建（TLR）。
PCI 的血管造影和临床成功率为 100%。所有患者均进行完全血运重建。平均随访时间为 2.5 年±10 个月，第 12 个月内死亡率为 3%，总 MACE 发生率为 30.6%。随访期间，4 例（5.5%）患者死亡。对 59 例（82%）患者进行了血管造影随访，治疗病变的 TLR 发生率为 18.05%。记录到 1 例可能的支架血栓形成。
考虑到我们大多数患者存在高手术风险，ULM 支架置入术是可行和安全的，具有极好的即刻和中期结果。长期结果似乎令人鼓舞，显示出有限的死亡率和完全没有确定或可能的血栓形成。
