Ospedale degli Infermi, ASL TO3, Rivoli (TO) Italy. gagnora@ libero.it
Catheter Cardiovasc Interv. 2012 May 1;79(6):979-87. doi: 10.1002/ccd.23225. Epub 2011 Oct 5.
Best revascularization strategy in patients with acute coronary syndromes (ACS) and unprotected left main (ULM) coronary disease is still debate reflecting lack of convincing data.
To assess clinical feasibility and efficacy of ULM percutaneous coronary intervention (PCI) in patients with ACS and describe the practice of a center without on-site surgical back-up over a 7-year period.
Data on high-risk patients with ACSs undergoing percutaneous ULM treatment were prospectively collected in an independent registry. Primary end-points of this study were immediate and long-term outcomes expressed as target lesion failure (TLF, composite of cardiac death, myocardial infarction (MI), and target lesion revascularization).
Between January 2003 and January 2010, 200 consecutive patients were included in this study. Angiographic success was obtained in 95% of patients but procedural success was 87% primarily affected by an 11% of in-hospital cardiac mortality. At median follow-up of 26 months (IQ 10-47), the overall TLF rate was 28.5%, with 16.0% of cardiac death, 7.0% of MI, and 10.5% of clinically driven target lesion revascularization rates. Cumulative definite/probable stent thrombosis was 3.5%. Elevated EuroSCORE value and pre-procedural hemodynamic instability were the strongest predictors of TLF. Temporal trend analysis showed progressive but not significant improvement for both immediate (P = 0.110) and long-term (P = 0.073) outcomes over the study period.
This single-center study based on current clinical practice in patient with ULM disease and ACS confirmed PCI as feasible revascularization strategy in absence of on-site cardio-thoracic support. Nevertheless, the outcome of these high-risk patients is still hampered by a sensible in-hospital mortality rate.
急性冠状动脉综合征（ACS）和无保护左主干（ULM）冠状动脉疾病患者的最佳血运重建策略仍存在争议，这反映出缺乏令人信服的数据。
评估 ACS 合并 ULM 病变患者行经皮冠状动脉介入治疗（PCI）的临床可行性和疗效，并描述在无现场心脏外科支持的情况下，一个中心在 7 年期间的实践情况。
前瞻性地在一个独立的登记处收集接受经皮 ULM 治疗的高危 ACS 患者的数据。本研究的主要终点是即刻和长期结果，表现为靶病变失败（TLF，包括心脏死亡、心肌梗死（MI）和靶病变血运重建）。
2003 年 1 月至 2010 年 1 月期间，共有 200 例连续患者纳入本研究。95%的患者获得了血管造影成功，但手术成功率为 87%，主要受到 11%的院内心脏死亡率的影响。在中位随访 26 个月（IQR 10-47）时，总的 TLF 发生率为 28.5%，其中 16.0%的心脏死亡，7.0%的 MI 和 10.5%的临床驱动的靶病变血运重建率。累积的明确/可能的支架血栓形成率为 3.5%。EuroSCORE 值升高和术前血流动力学不稳定是 TLF 的最强预测因素。时间趋势分析显示，在研究期间，即刻（P=0.110）和长期（P=0.073）结果均有渐进但无统计学意义的改善。
这项基于当前 ACS 合并 ULM 疾病患者临床实践的单中心研究证实，在无现场心脏外科支持的情况下，PCI 是可行的血运重建策略。然而，这些高危患者的结果仍然受到可感知的院内死亡率的影响。
