Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Japanese Red Cross Society Wakayama Medical Center.
Circ J. 2018 Dec 25;83(1):198-208. doi: 10.1253/circj.CJ-18-0896. Epub 2018 Nov 9.
Data on the clinical outcomes of percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) in patients with acute coronary syndrome (ACS) are limited. Therefore, this study aimed to assess the clinical outcome of patients with ACS who underwent PCI for LMCA culprit lesion.
Of 1,809 patients enrolled in the Assessing Optimal Percutaneous Coronary Intervention for the LMCA (AOI-LMCA) registry (a retrospective 6-center registry of consecutive patients undergoing LMCA stenting in Japan), the current study population consisited of 1,500 patients with unprotected LMCA stenting for LMCA ACS (ACS with shock: 115 patients, ACS without shock: 281 patients) and stable CAD (1,104 patients). The cumulative 180-day incidence of death was markedly higher in the ACS with shock group than in the other groups (49.5%, 8.6%, and 3.3%, respectively; P<0.0001), but mortality beyond 180-day was not significantly different among the 3 groups (30.2%, 20.4%, and 19.5%, respectively; P=0.65). In the ACS with shock group, the initial TIMI flow grade did not affect 5-year mortality (57.1% and 62.2%, P=0.99), but in the ACS without shock group, 5-year mortality was significantly higher in patients with initial TIMI flow grade ≤1 than in patients with TIMI flow grade ≥2 (44.4% and 23.7%, respectively; P=0.008).
In patients with LMCA ACS, survival correlates with baseline hemodynamic and coronary flow status.
急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）无保护左主干冠状动脉（LMCA）的临床结果数据有限。因此，本研究旨在评估接受 LMCA 罪犯病变 PCI 的 ACS 患者的临床结果。
在评估左主干冠状动脉经皮介入治疗的最佳策略（AOI-LMCA）登记研究（日本 6 家中心连续进行 LMCA 支架置入术的回顾性登记研究）中，共纳入 1809 例患者，其中 1500 例患者因 LMCA ACS（合并休克的 ACS：115 例，不合并休克的 ACS：281 例）和稳定性 CAD 行 LMCA 支架置入术。合并休克的 ACS 组 180 天累计死亡率明显高于其他两组（分别为 49.5%、8.6%和 3.3%；P<0.0001），但三组间 180 天后死亡率无显著差异（分别为 30.2%、20.4%和 19.5%；P=0.65）。在合并休克的 ACS 组中，初始 TIMI 血流分级对 5 年死亡率无影响（57.1%和 62.2%；P=0.99），但在不合并休克的 ACS 组中，初始 TIMI 血流分级≤1 的患者 5 年死亡率明显高于 TIMI 血流分级≥2 的患者（44.4%和 23.7%；P=0.008）。
在 LMCA ACS 患者中，生存率与基线血流动力学和冠状动脉血流状态相关。
