Kovac J D, de Bono D P
Department of Medicine, University of Leicester.
Heart. 1996 Jul;76(1):76-8. doi: 10.1136/hrt.76.1.76.
To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database.
Coordinating centre for national database.
Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies.
The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions.
The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting.
利用心脏导管并发症保密调查（CECCC）数据库，研究与左主干冠状动脉疾病或损伤相关的心脏导管并发症的发生率及转归情况。
国家数据库协调中心。
对一个全国性多中心心脏导管并发症数据库的报告进行回顾性分析。涉及左主干冠状动脉的并发症在录入时被标记出来。必要时，从参与中心获取额外信息。共登记了112,921例手术，其中12,849例为冠状动脉血管成形术，其余为诊断性检查。
记录有并发症的病例总数为993例（0.88%）。在这993例病例中，61例（6.14%）的并发症与左主干冠状动脉疾病或损伤有关。在这61例病例中，57例（93%）的并发症较为严重，需要进行复苏或立即进行冠状动脉搭桥手术。10例患者（16%）在导管室死亡，另有9例（15%）在24小时内死亡，共有23例患者（38%）在手术后1个月内死亡。左主干相关并发症占CECCC数据库总死亡率的17%。42例患者尝试进行了紧急冠状动脉搭桥手术，其中31例在1个月时存活。在所有6例报告的与经皮冠状动脉腔内血管成形术（PTCA）相关的并发症中，病因均为左主干冠状动脉的创伤性损伤。各级资历的操作人员发生并发症的比例相似。
左主干相关并发症的风险相对较低，但一旦发生，往往会危及生命，占导管相关总死亡率的五分之一。由于缺乏对左主干疾病具有良好预测价值的广泛可用的非侵入性检查，最佳的保障措施是操作技术要谨慎。发生并发症的患者应进行急诊冠状动脉搭桥手术。
