不适宜冠状动脉旁路移植术复杂小血管病变的冠状动脉介入治疗

Percutaneous coronary intervention of patients with complexsmall coronary artery lesion unsuitable for coronary artery bypass graft

目的探讨对伴左心室射血分数（INEF）降低的小血管复杂病变行冠状动脉介入（PCI）治疗的安全性和有效性。方法观察已行PCI治疗实现部分或完全血运重建的16例伴LVEF降低小血管复杂病变患者的手术即刻成功率、并发症，住院时间，术后12个月心功能、LVEF和左心室舒张末内径（LVDd）的改善，主要不良心脏事件（包括心源性死亡、心肌梗死、靶病变血运重建）。结果16例患者行PCI治疗即刻全部成功，无一例死亡，无严重并发症发生，住院时间（11±5）d。患者行PCI治疗后随访12个月，无主要不良心脏事件发生，心功能由术前Ⅲ-Ⅳ级改善为Ⅰ-Ⅱ级，LVEF由术前25％～45％[（29±8）％]提高到32％～48％[（37±7）％]，LVDd由术前52—79（66±11）mm缩短至49—68（58±8）mm。术后12个月14例患者复查冠状动脉造影，无支架内血栓形成，2例患者出现支架内再狭窄。结论对伴LVEF降低小血管复杂病变患者，行PCI治疗是安全有效的。有利于降低冠心病心力衰竭的病死率，改善患者长期预后。

Objective To investigate the safety and efficacy of percutaneous coronary intervention （PCI） in patients with low left ventricular ejection fraction （LVEF） and complex small coronary artery lesions. Methods Complete or partial post-PCI revascularization of coronary artery was employed in 16 patients with a low LVEF and complex small coronary artery lesions who were unsuitable for CABG （ coronary artery bypass grafting ）. All cases were observed with regards to immediate success rate of operation, complication, hospitalization duration, improvement of cardiac function and LVEF and major adverse cardiac events （including cardiac death, myocardial infarction and target lesion revascularization） at 12 months postoperation. Results All cases were successfully treated without death and severe complications while the hospitalization duration was （ 11 ±5 ） days. The follow-up survey at 12 months post-operation showed that no major adverse cardiac event occurred, the post-operative improvement of cardiac function was from Ⅲ-Ⅳgrade toⅠ-Ⅱgrade, the improvement of LVEF was from 25%--45% [（29 ± 8）%] to 32%--48% [（37 ± 7 ） % ] , left ventricular end diastolic diameter （ LVDd ） was shortened from 52--79 （ 66 ±11 ）mm to 49-68 （58 ±8）mm. The reexamination of 14 cases by coronary angiography at 12 months post-operation showed that there was no intra-stent thrombosis while 20%--40% intra-stent restenosis occurred in 2 cases. Conclusion For patients with a low LVEF and complex small coronary artery lesions, PCI is a safe and effective method to lower the mortality rate of CHD patients with heart failure and improve the long-term patient prognosis.