介入治疗冠状动脉左主干病变临床研究

Clinical Outcomes of Percutaneous Coronary Intervention for Left Main Coronary Artery Stenosis

目的研究经皮冠脉介入术(PCI)和冠脉旁路移植术(CABG)对冠状动脉左主干病变的疗效和安全性.方法回顾性收集2005年5月至2008年10月在昆明医学院附一院及云南省内部分医院心内科住院治疗的30例左冠状动脉主干病变行PCI治疗的患者为PCI组,另收集2007年3月至2008年10月在昆明医学院附一院心外科住院治疗的16例冠状动脉搭桥治疗左主干病变患者为CABG组.观察PCI组及CABG组患者的临床特征.并对上述两组患者进行随访,观察死亡、非致死性心肌梗死、靶血管血运重建术、脑血管事件等终点事件的发生情况及心绞痛复发情况.结果两组的临床特征基本相近.PCI组有5例(16.7%)左主干末端分叉病变达到Ⅲ级病变,而CABG组8例(50.0%)左主干末端分叉病变达到Ⅲ级病变,P=0.045,差异有统计学差异.PCI组中药物洗脱支架(DES)应用占绝对优势(97.0%),左主干病变支架置入成功率为100%.两组在心绞痛复发率、再次心肌梗死、血运重建率、主要不良心脏事件(MACE)发生率、主要不良心脑事件(MACCE)发生率均无统计学意义.PCI组中急性冠脉综合症(ACS)与非ACS远期疗效比较在心绞痛复发率(29.4%VS0.0%,P<0.05)及MACE发生率(41.2%VS7.6%,P<0.05)差异有统计学意义.结论 (1)经选择无保护左主干病变PCI治疗的疗效与CABG治疗左主干病变比较PCI是可行和安全的,并取得较好的近远期疗效.(2)急性冠脉综合征可能是影响心绞痛复发率及MACE的因素之一.

Objective To study the effect and safety of PCI and CABG in patients with left main coronary artery stenosis.Methods From May 2005 to October 2008,30 patients with left main coronary artery stenosis who received PCI in the Department of cardiology in the 1st Affiliated Hospital of Kunming Medical University and other hospitals were selected in PCI group.As control,16 patients with left main coronary artery stenosis who received CABG in the Department of cardiac surgery in the 1st Affiliated Hospital of Kunming Medical University from March 2007 to October 2008 were selected in CABG group.The clinical data of patients who received PCI or CABG were observed.All patients were followed up,and the major adverse cardiac events（including death,MI,TVR,and angina）and the major adverse cardiac cerebrovascular events of patients were observed.Results The clinical data of patients in PCI group and CABG group were similar.The distal bifurcation stenosis with 3 grade was found in 5（16.7%）patients in PCI group and 8（50.0%）in CABG group（P〈0.05）.The application rate of DES was 97.0%,and the success rate of left main coronary artery stents implantation were 100% in PCI group.There was no significant difference in the recurrence rate of angina,myocardial infarction,TVR,the incidence of major adverse cardiac events and major adverse cardiac cerebrovascular events between the two groups.There was a significant difference in the recurrence rate of angina and the incidence of major adverse cardiac events between patients with ACS and patients without ACS in PCI group（29.4% VS 0%,and 41.2% VS 7.6%,P〈0.05）.Conclusion（1）Compared with CABG,PCI for selected patients with unprotected LMCA stenosis is feasible and safe and has good short and long term effects.（2） Acute coronary syndrome may be one of the main influencing factors of the recurrence rate of angina and the incidence of major adverse cardiac events