Yamamoto Kei, Sakakura Kenichi, Akashi Naoyuki, Watanabe Yusuke, Noguchi Masamitsu, Taniguchi Yousuke, Wada Hiroshi, Momomura Shin-Ichi, Fujita Hideo
Division of Cardiology, Department of Cardiovascular, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
Heart Vessels. 2018 Jan;33(1):33-40. doi: 10.1007/s00380-017-1033-0. Epub 2017 Aug 3.
Percutaneous coronary interventions to ostial left anterior descending artery (LAD)-acute myocardial infarction (AMI) were challenging, especially in crossover stenting from left main trunk (LMT) to LAD. The clinical outcomes of ostial LAD-AMI that needed crossover stenting were not well investigated. The objective of this study was to compare the clinical outcomes of LMT crossover stenting with those of ostial LAD just proximal (jp) stenting. Between January 2009 and March 2016, 1499 patients were diagnosed as AMI in our institution. Among them, 76 ostial LAD-AMIs were included in this study, and divided into 30 LMT crossover stenting (the crossover group) and 46 jp stenting (the jp stenting group). The primary endpoint was major cardiovascular events (MACE) defined as the composite of cardiac death, acute myocardial infarction (AMI), stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). The frequency of MACE was comparable between the 2 groups (16.7% in the crossover group and 21.7% in the jp stenting group, P = 0.587). Similarly, the frequency of cardiac death was comparable between the 2 groups (6.7% in the crossover group and 13.0% in the jp stenting group, P = 0.376). The frequencies of TLR (6.7% in the crossover group and 6.5% in the jp stenting group, P = 0.980) and TVR (10.0% in the crossover group and 8.7% in the jp stenting group, P = 0.848) were not significantly different between the 2 groups. In conclusion, the clinical outcomes of the crossover stenting were comparable to the jp stenting in the stenting strategy for ostial LAD-AMI. LMT-LAD crossover stenting would be the acceptable strategy for ostial LAD-AMI.
经皮冠状动脉介入治疗左前降支（LAD）开口处急性心肌梗死（AMI）具有挑战性，尤其是在从左主干（LMT）到LAD的交叉支架置入术中。对于需要交叉支架置入术的LAD开口处AMI的临床结局，尚未进行充分研究。本研究的目的是比较LMT交叉支架置入术与LAD开口处近端（jp）支架置入术的临床结局。2009年1月至2016年3月期间，我院1499例患者被诊断为AMI。其中，76例LAD开口处AMI纳入本研究，并分为30例行LMT交叉支架置入术（交叉组）和46例行jp支架置入术（jp支架置入组）。主要终点是主要心血管事件（MACE），定义为心源性死亡、急性心肌梗死（AMI）、支架血栓形成（ST）、靶病变血运重建（TLR）和靶血管血运重建（TVR）的复合终点。两组间MACE的发生率相当（交叉组为16.7%，jp支架置入组为21.7%，P = 0.587）。同样，两组间心源性死亡的发生率相当（交叉组为6.7%，jp支架置入组为13.0%，P = 0.376）。两组间TLR（交叉组为6.7%，jp支架置入组为6.5%，P = 0.980）和TVR（交叉组为10.0%，jp支架置入组为8.7%，P = 0.848）的发生率无显著差异。总之，在LAD开口处AMI的支架置入策略中，交叉支架置入术的临床结局与jp支架置入术相当。LMT-LAD交叉支架置入术将是LAD开口处AMI的可接受策略。
