经皮冠状动脉介入治疗无保护左主干冠状动脉疾病的裸金属支架的长期结果。

Very long-term outcomes after percutaneous coronary intervention with bare metal stents for unprotected left main coronary artery disease.

机构信息

Division of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka. Japan.

出版信息

EuroIntervention. 2012 Dec 20;8(8):962-9. doi: 10.4244/EIJV8I8A146.

DOI:10.4244/EIJV8I8A146

PMID:23014985

Abstract

AIMS

The aim of this study was to evaluate very long-term clinical outcomes and potential predictors after percutaneous coronary intervention (PCI) with bare metal stents (BMS) for unprotected left main coronary artery disease (ULMCAD).

METHODS AND RESULTS

From March 1991 to August 2001, 151 patients who underwent PCI with BMS for ULMCAD were investigated retrospectively. The patient-oriented major adverse cardiac events (MACE) were defined as the occurrence of all-cause death, any MI, and any coronary revascularisation. The median follow-up duration was 10.5 years. The mean age was 69.9±11.5 years, and 106 patients (70.2%) were male. At 10 years, the incidences of cardiac death (CD), target lesion revascularisation (TLR) and patient-oriented MACE were 11.1%, 25.2% and 81.9%, respectively. In multivariate analysis, the pre-reference diameter of the left main trunk (LMT) was significantly associated with TLR (adjusted hazard ratio [HR] [95% confidence interval (CI)], 0.28 [0.14-0.54], p<0.001) and the SYNTAX score remained an independent predictor of patient-oriented MACE (adjusted HR [95% CI], 1.03 [1.007-1.05], p=0.009).

CONCLUSIONS

The pre-reference diameter of LMT was significantly associated with TLR, and the SYNTAX score significantly predicted the risk of patient-oriented MACE at 10 years. BMS implantation for larger size of ULMCAD with a lower SYNTAX score was feasible for up to 10 years.

摘要

目的

本研究旨在评估经皮冠状动脉介入治疗（PCI）使用裸金属支架（BMS）治疗无保护左主干冠状动脉疾病（ULMCAD）的极长期临床结果和潜在预测因素。

方法和结果

从 1991 年 3 月至 2001 年 8 月，回顾性调查了 151 例接受 PCI 治疗 ULMCAD 的患者。以患者为导向的主要不良心脏事件（MACE）定义为全因死亡、任何心肌梗死和任何冠状动脉血运重建的发生。中位随访时间为 10.5 年。患者平均年龄为 69.9±11.5 岁，106 例（70.2%）为男性。在 10 年时，心脏死亡（CD）、靶病变血运重建（TLR）和患者导向的 MACE 的发生率分别为 11.1%、25.2%和 81.9%。多变量分析显示，左主干（LMT）的参考直径与 TLR 显著相关（调整后的危险比[HR] [95%置信区间（CI）]，0.28 [0.14-0.54]，p<0.001），而 SYNTAX 评分仍然是患者导向的 MACE 的独立预测因子（调整后的 HR [95% CI]，1.03 [1.007-1.05]，p=0.009）。