Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan.
Catheter Cardiovasc Interv. 2013 Nov 1;82(5):757-64. doi: 10.1002/ccd.24988. Epub 2013 Jun 14.
To report the clinical outcomes of single-stenting from distal unprotected left main coronary artery (LMCA) to the left circumflex artery (LCx).
Percutaneous coronary intervention of distal LMCA is usually performed by stenting into the left anterior descending artery (LAD). In some cases, stenting from LMCA to LCx alone is performed.
Between April 2002 and April 2011, single-stenting with drug-eluting stents for distal unprotected LMCA disease was performed in 584 patients. Thirty-one patients underwent LMCA-LCx stenting, who were compared with the remaining 553 LMCA-LAD stented patients.
At 3-year follow-up, there were no significant differences between LMCA-LCx and LMCA-LAD stenting groups in major adverse cardiac events (24.1% vs. 19.6%; P = 0.540), cardiac death, and myocardial infarction. A trend toward higher target lesion revascularization (TLR) in the LMCA-LCx stenting group was noted. This was significant when the stented branch was only considered (18.2% vs. 3.0%; P < 0.001). In both TLR subgroups, LCx ostium was frequently involved (83.3% in LMCA-LCx vs. 66.2% in LMCA-LAD TLR subgroups; P = 0.39). The LAD ostium was more frequently involved in LMCA-LCx TLR subgroup (83.3% vs. 21.0%; P < 0.001). On the multivariable Cox regression analysis, LMCA-LCx stenting was an independent predictor of TLR for restenosis at the ostium of the stented branch (HR 6.49; 95% CI 2.27-18.53; P < 0.001).
TLR rate at the LCx ostium is high irrespective of LMCA-LCx or LMCA-LAD stenting. The former also seems to be associated with high TLR at the LAD ostium. It may therefore be important to evaluate alternative strategies for treating distal LMCA disease that extends into the LCx but not LAD.
报告经左主干（LMCA）远端无保护支至回旋支（LCx）单支架置入术的临床结果。
LMCA 远端的经皮冠状动脉介入治疗通常通过支架置入前降支（LAD）进行。在某些情况下，仅对 LMCA 至 LCx 进行支架置入。
2002 年 4 月至 2011 年 4 月，584 例患者接受药物洗脱支架治疗 LMCA 远端无保护病变，其中 31 例患者行 LMCA-LCx 支架置入术，与其余 553 例行 LMCA-LAD 支架置入术的患者进行比较。
3 年随访时，LMCA-LCx 组和 LMCA-LAD 组在主要不良心脏事件（24.1% vs. 19.6%；P = 0.540）、心脏死亡和心肌梗死方面无显著差异。LMCA-LCx 支架置入组的靶病变血运重建（TLR）发生率呈升高趋势，但仅考虑支架置入支时差异有统计学意义（18.2% vs. 3.0%；P < 0.001）。在两个 TLR 亚组中，LCx 开口均较常受累（LMCA-LCx 组 83.3%，LMCA-LAD TLR 亚组 66.2%；P = 0.39）。LMCA-LCx TLR 亚组中 LAD 开口更常受累（83.3% vs. 21.0%；P < 0.001）。多变量 Cox 回归分析显示，LMCA-LCx 支架置入是支架置入支开口处再狭窄 TLR 的独立预测因素（HR 6.49；95%CI 2.27-18.53；P < 0.001）。
LCx 开口处的 TLR 发生率高，无论行 LMCA-LCx 支架置入术还是 LMCA-LAD 支架置入术。前者似乎也与 LAD 开口处的高 TLR 相关。因此，对于治疗延伸至 LCx 但不延伸至 LAD 的 LMCA 远端病变，可能需要评估替代治疗策略。
