Wakayama Medical Center, Wakayama, Japan.
JACC Cardiovasc Interv. 2013 Jul;6(7):654-63. doi: 10.1016/j.jcin.2013.03.015.
This study assessed 5-year outcomes after implantation of sirolimus-eluting stents (SES) for unprotected left main coronary artery (ULMCA) disease in comparison with that for non-left main disease.
More information on long-term outcomes after ULMCA stenting is needed.
The j-Cypher is a multicenter prospective registry of consecutive patients undergoing SES implantation in Japan.
Among 12,812 patients enrolled in the j-Cypher registry, the unadjusted mortality rate at 5 years was significantly higher in patients with ULMCA stenting than in patients without ULMCA stenting (22.8% vs. 14.1%; p < 0.0001); however, the risk for death with ULMCA stenting was no longer significant after adjusting for confounders (hazard ratio: 1.18, 95% confidence interval: 0.95 to 1.46; p = 0.14). In the lesion-level comparison, the nonbifurcation ULMCA lesions treated exclusively with SES had a significantly lower rate of target lesion revascularization (TLR) than those in non-ULMCA nonbifurcation lesions (2.4% vs. 12.7%; p = 0.04). Among bifurcation lesions, those treated with a provisional 2-stent approach had similar rates of TLR (12.1% vs. 11.4%; p = 0.79) between the ULMCA and non-ULMCA groups. Lesions treated with an elective 2-stent approach had higher TLR rates in the ULMCA group as compared with the non-ULMCA group (33.5% vs. 19.7%; p = 0.002).
The safety of ULMCA stenting relative to non-LMCA stenting was maintained through 5 years follow-up. In terms of efficacy, SES implantation in nonbifurcation ULMCA lesions was associated with an extremely low cumulative incidence of TLR, whereas the elective 2-stent approach for ULMCA bifurcation lesions was associated with a markedly higher cumulative incidence of TLR as compared with that for non-ULMCA bifurcation lesions.
本研究旨在评估与非左主干病变相比，无保护左主干冠状动脉（ULMCA）疾病患者植入西罗莫司洗脱支架（SES）后 5 年的结果。
需要更多关于 ULMCA 支架置入后长期结果的信息。
j-Cypher 是一项多中心前瞻性登记研究，纳入了在日本接受 SES 植入术的连续患者。
在 j-Cypher 登记研究的 12812 例患者中，未校正的 5 年死亡率在接受 ULMCA 支架置入术的患者中明显高于未接受 ULMCA 支架置入术的患者（22.8% vs. 14.1%；p<0.0001）；然而，在校正混杂因素后，ULMCA 支架置入术的死亡风险不再显著（风险比：1.18，95%置信区间：0.95 至 1.46；p=0.14）。在病变水平比较中，仅用 SES 治疗的非分叉 ULMCA 病变的靶病变血运重建（TLR）率明显低于非 ULMCA 非分叉病变（2.4% vs. 12.7%；p=0.04）。在分叉病变中，采用临时两支架方法治疗的病变在 ULMCA 组和非 ULMCA 组的 TLR 发生率相似（12.1% vs. 11.4%；p=0.79）。采用选择性两支架方法治疗的病变在 ULMCA 组的 TLR 发生率高于非 ULMCA 组（33.5% vs. 19.7%；p=0.002）。
在 5 年随访期间，与非 LMCA 支架置入术相比，ULMCA 支架置入术的安全性得以维持。在疗效方面，非分叉 ULMCA 病变植入 SES 与 TLR 的累积发生率极低相关，而 ULMCA 分叉病变采用选择性两支架方法与非 ULMCA 分叉病变相比，TLR 的累积发生率明显更高。
