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血管造影引导下单支架置入技术治疗非复杂性左主干冠状动脉疾病的三年主要临床结局

Three-Year Major Clinical Outcomes of Angiography-Guided Single Stenting Technique in Non-Complex Left Main Coronary Artery Diseases.

作者信息

Kim Yong Hoon, Her Ae-Young, Rha Seung-Woon, Choi Byoung Geol, Shim Minsuk, Choi Se Yeon, Byun Jae Kyeong, Li Hu, Kim Woohyeun, Kang Jun Hyuk, Choi Jah Yeon, Park Eun Jin, Park Sung Hun, Lee Sunki, Na Jin Oh, Choi Cheol Ung, Lim Hong Euy, Kim Eung Ju, Park Chang Gyu, Seo Hong Seog, Oh Dong Joo

机构信息

Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine.

Department of Medicine, Korea University Graduate School.

出版信息

Int Heart J. 2017 Oct 12;58(5):704-713. doi: 10.1536/ihj.17-115. Epub 2017 Sep 30.

Abstract

There is limited long-term comparative clinical outcome data concerning angiography- versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in non-complex left main coronary artery (LMCA) disease treated with the single stenting technique in the drug-eluting stent (DES) era.The aim of this study was to investigate whether angiography-guided stenting is comparable to IVUS-guided stenting during 3-year clinical follow-up periods in patients with non-complex LM disease treated with the single stenting technique.A total of 196 patients treated with either angiography-guided (n = 74) or IVUS-guided (n = 122) PCI were included. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR). To adjust for any potential confounders, propensity score (PS) adjusted analysis was performed.During 3-year follow-up, the PS adjusted Cox-proportional hazard ratio (HR) was not significantly different between the two groups for total death, cardiac death, and MI. Also, TLR and the combined rates of TVR and non-TVR were not significantly different. Finally, MACE was not significantly different between the two groups (HR: 0.63, 95% Confidence interval (CI): 0.33-1.17; P = 0.149).Angiography-guided PCI for non-complex LMCA diseases treated with the single stenting technique showed comparable results compared with IVUS-guided PCI in reducing clinical events during 3-year clinical follow-up in the DES era. Although IVUS guided PCI is the ideal strategy, angiography-guided PCI can be an option for LMCA PCI in some selected cases.

摘要

在药物洗脱支架(DES)时代,对于采用单支架技术治疗的非复杂性左主干冠状动脉(LMCA)疾病,关于血管造影引导与血管内超声(IVUS)引导的经皮冠状动脉介入治疗(PCI)的长期比较临床结局数据有限。本研究的目的是调查在采用单支架技术治疗的非复杂性LM疾病患者的3年临床随访期内,血管造影引导支架置入术与IVUS引导支架置入术是否具有可比性。总共纳入了196例接受血管造影引导(n = 74)或IVUS引导(n = 122)PCI治疗的患者。主要结局是定义为全因死亡、非致命性心肌梗死(MI)、靶病变血运重建(TLR)、靶血管血运重建(TVR)和非靶血管血运重建(非TVR)的主要不良心脏事件(MACE)的发生情况。为了调整任何潜在的混杂因素,进行了倾向评分(PS)调整分析。在3年随访期间,两组在全因死亡、心源性死亡和MI方面的PS调整Cox比例风险比(HR)无显著差异。此外,TLR以及TVR和非TVR的合并发生率也无显著差异。最后,两组之间的MACE无显著差异(HR:0.63,95%置信区间(CI):0.33 - 1.17;P = 0.149)。在DES时代,采用单支架技术治疗的非复杂性LMCA疾病的血管造影引导PCI在3年临床随访期间减少临床事件方面与IVUS引导PCI显示出可比的结果。虽然IVUS引导的PCI是理想策略,但在某些选定病例中,血管造影引导的PCI可以作为LMCA PCI的一种选择。

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