Lee Wei-Chieh, Tsai Tzu-Hsien, Chen Yung-Lung, Yang Cheng-Hsu, Chen Shyh-Ming, Chen Chien-Jen, Lin Cheng-Jei, Cheng Cheng-I, Hang Chi-Ling, Wu Chiung-Jen, Yip Hon-Kan
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute of Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
PLoS One. 2014 Oct 20;9(10):e109281. doi: 10.1371/journal.pone.0109281. eCollection 2014.
This study evaluated the feasibility, safety, and prognostic outcome in patients with significant unprotected left main coronary artery (ULMCA) disease undergoing stenting.
Between January 2010 and December 2012, totally 309 patients, including those with stable angina [13.9% (43/309)], unstable angina [59.2% (183/309)], acute non-ST-segment elevation myocardial infarction (NSTEMI) [24.3% (75/309)], and post-STEMI angina (i.e., onset of STEMI<7 days) [2.6% (8/309)] with significant ULMCA disease (>50%) undergoing stenting using transradial arterial approach, were consecutively enrolled. The patients' mean age was 68.9±10.8 yrs. Incidences of advance congestive heart failure (CHF) (defined as ≥ NYHA Fc 3) and multi-vessel disease were 16.5% (51/309) and 80.6% (249/309), respectively. Mechanical supports, including IABP for critical patients (defined as LVEF <35%, advanced CHF, or hemodynamically unstable) and extra-corporeal membrane oxygenator (ECMO) for hemodynamically collapsed patients, were utilized in 17.2% (53/309) and 2.6% (8/409) patients, respectively. Stent implantation was successfully performed in all patients. Thirty-day mortality rate was 4.5% (14/309) [cardiac death: 2.9% (9/309) vs. non-cardiac death: 1.6% (5/309)] without significant difference among four groups [2.3% (1) vs. 2.7% (5) vs. 9.3% (7) vs. 12.5% (1), p = 0.071]. Multivariate analysis identified acute kidney injury (AKI) as the strongest independent predictor of 30-day mortality (p<0.0001), while body mass index (BMI) and white blood cell (WBC) count were independently predictive of 30-day mortality (p = 0.003 and 0.012, respectively).
Catheter-based LM stenting demonstrated high rates of procedural success and excellent 30-day clinical outcomes. AKI, BMI, and WBC count were significantly and independently predictive of 30-day mortality.
本研究评估了接受支架置入术的严重无保护左主干冠状动脉（ULMCA）疾病患者的可行性、安全性和预后结果。
2010年1月至2012年12月期间，连续纳入了309例严重ULMCA疾病（>50%）的患者，包括稳定型心绞痛患者[13.9%（43/309）]、不稳定型心绞痛患者[59.2%（183/309）]、急性非ST段抬高型心肌梗死（NSTEMI）患者[24.3%（75/309）]和STEMI后心绞痛患者（即STEMI发作<7天）[2.6%（8/309）]，这些患者采用经桡动脉途径进行支架置入术。患者的平均年龄为68.9±10.8岁。晚期充血性心力衰竭（CHF，定义为≥NYHA Fc 3级）和多支血管病变的发生率分别为16.5%（51/309）和80.6%（249/309）。分别有17.2%（53/309）和2.6%（8/409）的患者使用了机械支持，包括用于病情危急患者（定义为左心室射血分数<35%、晚期CHF或血流动力学不稳定）的主动脉内球囊反搏（IABP）和用于血流动力学衰竭患者的体外膜肺氧合（ECMO）。所有患者均成功进行了支架植入。30天死亡率为4.5%（14/309）[心源性死亡：2.9%（9/309）与非心源性死亡：1.6%（5/309）]，四组之间无显著差异[2.3%（1）与2.7%（5）与9.3%（7）与12.5%（1），p = 0.071]。多变量分析确定急性肾损伤（AKI）是30天死亡率最强的独立预测因素（p<0.0001），而体重指数（BMI）和白细胞（WBC）计数是30天死亡率的独立预测因素（分别为p = 0.003和0.012）。
基于导管的左主干支架置入术显示出较高的手术成功率和良好的30天临床结果。AKI、BMI和WBC计数是30天死亡率的显著且独立的预测因素。
