Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
J Interv Cardiol. 2021 Jan 12;2021:8829686. doi: 10.1155/2021/8829686. eCollection 2021.
This study sought to report the 10-year clinical outcomes of patients who underwent unprotected left main (LM) percutaneous coronary intervention (PCI) in a large centre.
A total of 913 consecutive patients who underwent unprotected LM PCI from January 2004 to December 2008 at Fu Wai Hospital were retrospectively analysed; the mean age was 60.0 ± 10.9 years, females accounted for 22% of patients, diabetes was present in 27.7% of patients, and an LM bifurcation lesion occurred in 82.9% of patients. During the median follow-up of 9.7 years, major adverse cardiac or cerebrovascular events (MACCEs) occurred in 25.6% (234) of patients, and the rates of all-cause death, myocardial infarction, and stroke were 14.9%, 11.0%, and 7.1%, respectively. Cardiac death occurred in only 7.9% of patients. The estimated event rate was 41.9% for death/myocardial infarction/any revascularization and 45.9% for death/MI/stroke/any revascularization. Definite/probable stent thrombosis occurred in 4.3% (39) of patients. According to the subgroup analysis, IVUS-guided PCI was associated with less long-term MACCEs. Further multivariate analysis identified that age and LVEF<40% were the only independent predictors for 10-year death. Age, LVEF<40%, creatinine clearance, and incomplete revascularization were independent predictors for death/MI, while a two-stent strategy, diabetes, a transradial approach, and the use of bare metal stents (BMSs) or first-generation drug-eluting stents (DESs) were not.
Unprotected LM PCI in a large cohort of consecutive patients in a single large centre demonstrated favourable long-term outcomes up to 10 years even with the use of BMSs and first-generation of DESs.
本研究旨在报告在一个大型中心接受非保护左主干（LM）经皮冠状动脉介入治疗（PCI）的患者的 10 年临床结果。
回顾性分析 2004 年 1 月至 2008 年 12 月期间在阜外医院接受非保护 LM PCI 的 913 例连续患者；平均年龄为 60.0±10.9 岁，女性占患者的 22%，27.7%的患者患有糖尿病，82.9%的患者发生 LM 分叉病变。在中位随访 9.7 年期间，25.6%（234 例）的患者发生主要不良心脑血管事件（MACCEs），全因死亡、心肌梗死和卒中年发生率分别为 14.9%、11.0%和 7.1%。仅 7.9%的患者发生心脏性死亡。死亡/心肌梗死/任何血运重建的估计事件发生率为 41.9%，死亡/心肌梗死/卒中和任何血运重建的发生率为 45.9%。确定/可能的支架血栓形成发生率为 4.3%（39 例）。根据亚组分析，血管内超声指导的 PCI 与较低的长期 MACCEs 相关。进一步的多变量分析确定，年龄和 LVEF<40%是 10 年死亡的唯一独立预测因素。年龄、LVEF<40%、肌酐清除率和不完全血运重建是死亡/心肌梗死的独立预测因素，而双支架策略、糖尿病、经桡动脉入路以及使用裸金属支架（BMS）或第一代药物洗脱支架（DES）不是。
在一个大型中心的连续患者的大型队列中进行非保护 LM PCI 甚至使用 BMS 和第一代 DES 也能在 10 年内获得良好的长期结果。
