无保护左主干病变应用药物洗脱支架介入治疗的预后及影响因素分析

Prognosis and Influencing Factors of Unprotected Left Main Coronary Artery Intervention With Drug-Eluting Stents

目的:评价无保护左主干病变应用药物洗脱支架治疗的预后及影响因素。方法:2003-04至2008-06我院150例无保护左主干病变患者接受经皮冠状动脉介入治疗(PCI),平均年龄62.5±10.82(38～83)岁,根据病变是否累及左主干远端分叉分组,开口或体部病变为非分叉病变组(n=35),累及左主干远端或前降支、回旋支开口者为分叉病变组(n=115)。44例(29.33%,44/150)患者术中应用血管内超声指导,48例(32.43%,48/148)在平均(10.02±7.47)个月进行了冠状动脉造影复查。结果:术后存活的148例患者中125例(84.45%)随访成功,平均随访时间9.86±8.46(1～43)月,分叉病变组的再发心绞痛率(33.68%vs13.33%,P=0.0467)明显高于非分叉病变组,主要心脏不良事件(MACE)两组未见明显差异。对MACE单因素分析发现,血管内超声指导患者MACE的发生率明显低于无血管内超声指导患者(4.17%vs17.65%,P=0.0446)。影响再狭窄的因素分析显示双支架术的再狭窄率明显高于单支架术(64.29%vs10.71%,P=0.0011)。结论:经选择的无保护左主干病变,药物洗脱支架治疗是可行和安全的,可取得较好的近远期结果,经血管内超声指导MACE可明显减少。

Objective： To evaluate the prognosis and influencing factors of unprotected left main coronary artery intervention with drug-eluting stents. Methods： We summarized 150 patients who underwent unprotected left main coronary artery stenting by percutaneous coronary intervention（PCI） from April 2003 to June 2008, the patients mean ages was （62. 5 ± 10. 82 ）years, and 44 cases （29. 34% ） were guided by intravascular ultrasound（IVUS） during PCI. There were 48 cases（ 32.43% ）were reviewed by coronary angiography at（ 10.02 ±7.47） months after PCI. Results： There were 125 （84. 45% ）patients successfully finished the follow-up study for the average of（9. 86 ± 8.46） months. Recurrent angina pectoris in the group of the distal bifurcation lesion were more than that in non-bifurcation lesion group （33.68 % vs. 13.33 %, P = 0. 0467 ）, but there was no significant difference between those two groups in terms of major adverse cardiac events（MACE） during the follow-up period. Single-variable analysis showed that MACE in IVUS guided PCI was less than that in non-IVUS guided PCI（4. 17% vs. 17.65%, P =0. 0446）, it also presented that the re-stenosis rate in two-stent PCI was higher than that in one-stentt PCI（64. 29% vs. 10. 71%, P =0. 0011 ）. Conclusion： PCI with DES was safe and feasible for the treatment of selective left main coronary artery disease; it could bring the better short and long-term outcomes. IVUS guided PCI could significantly reduce MACE.