Martin-Yuste Victoria, Alvarez-Contreras Luis, Brugaletta Salvatore, Ferreira-Gonzalez Ignacio, Cola Clarissa, Garcia-Picart Joan, Martí Vicens, Sabate Manel
Department of Cardiology, Clinic Thorax Institute, Hospital Clinic de Barcelona, Villaroel 170, Planta 6 Esc 3, 08036, Barcelona, Spain.
J Invasive Cardiol. 2011 Oct;23(10):392-7.
Unprotected left main (ULM) coronary disease is considered by contemporary guidelines a class I indication for surgery. However, percutaneous coronary intervention (PCI) is often carried out in the ULM in either emergent or high-risk elective procedures. The aim of this study was to evaluate ULM-PCI as a feasible and safe procedure in the emergent setting, and to analyze outcomes in both scenarios.
Angiographic and clinical data were collected retrospectively for all patients who underwent emergent or elective PCI on ULM at our center from January 2006 to June 2009. All patients were followed up with a clinical visit or telephone interview. Main outcomes included major adverse cardiac events (MACE) and its individual components: cardiac death, myocardial infarction (MI) and target lesion revascularization. These were analyzed at the longest follow-up available.
A total of 98 consecutive patients with significant LM disease were included. Fifty-seven of them were treated as a planned procedure (elective group) and 41 as an emergent procedure (emergent group). Procedural success was achieved in 100% of cases in the elective group and in 88% of the emergent group (p = 0.011). Higher use of drug-eluting stents (DES) was recorded in the elective group (75% versus 45% in the emergent group; p <0.002). The emergent group presented a higher in-hospital mortality (24% versus 2% in the elective group; p <0.001). At a mean follow-up of 626 ± 380 days, the overall MACE rate was similar betweeen the two groups (23% in the emergent group versus 17% in the elective group; p = 0.52). Independent predictors of MACE after discharge follow-up were postprocedure minimal diameter and DES use.
Emergent PCI of the ULM exhibits worse in-hospital outcomes as compared to elective procedures. However, after discharge, long-term outcomes remain comparably good between groups.
当代指南将无保护左主干（ULM）冠状动脉疾病视为手术的I类适应症。然而，在急诊或高风险择期手术中，经皮冠状动脉介入治疗（PCI）常在ULM中进行。本研究的目的是评估急诊情况下ULM-PCI作为一种可行且安全的手术，并分析两种情况下的结果。
回顾性收集2006年1月至2009年6月在本中心接受急诊或择期ULM-PCI的所有患者的血管造影和临床数据。所有患者均通过临床就诊或电话访谈进行随访。主要结局包括主要不良心脏事件（MACE）及其各个组成部分：心源性死亡、心肌梗死（MI）和靶病变血运重建。在可获得的最长随访期对这些进行分析。
共纳入98例连续的严重左主干疾病患者。其中57例作为计划性手术治疗（择期组），41例作为急诊手术治疗（急诊组）。择期组100%的病例手术成功，急诊组为88%（p = 0.011）。择期组药物洗脱支架（DES）的使用比例更高（75%，而急诊组为45%；p <0.002）。急诊组院内死亡率更高（24%，而择期组为2%；p <0.001）。在平均随访626±380天时，两组的总体MACE发生率相似（急诊组为23%，择期组为17%；p = 0.52）。出院后随访MACE的独立预测因素是术后最小直径和DES的使用。
与择期手术相比，ULM的急诊PCI显示出更差的院内结局。然而，出院后，两组之间的长期结局仍然相当好。
