药物缓释支架治疗无保护左主干病变的近远期疗效

The immediate and long-term curative efficacy of drug-eluting stents in treating patients with unprotected left main coronary artery disease

目的:观察和评价药物缓释支架(DES)治疗无保护左主干病变(ULMCAD)的有效性和安全性。方法:回顾性分析68例行DES治疗的ULMCAD患者,搜集患者临床资料并应用Syntax积分进行危险分层。定期随访,追踪全因性死亡、心肌梗死、脑卒中、靶血管再次血运重建等主要不良心脑血管事件(MACCE)的发生情况。结果:68例ULMCAD患者中男48例,女20例;年龄(62±10)岁,合并高血压41例,合并糖尿病12例,Syntax积分(25.7±9.7)分。随访(35±16)个月,全因性死亡3例,心肌梗死4例;29例行冠状动脉造影复查,再狭窄并再次PCI 7例;冠状动脉旁路移植术(CABG)1例。1年MACCE 10例(15%),随访终点总MACCE 15例(22%)。Syntax积分高危组总MACCE发生率明显高于低中危组(44%对比15%,P﹤0.05)。结论:DES治疗ULMCAD安全有效,对Syntax积分小于33分的ULMCAD行介入治疗预后较好。

Objective：To observe and evaluate the validity and safety of drug-eluting stents（DES） for patients with unprotected left main coronary artery disease（ULMCAD）.Methods：The clinical data of patients with ULMCAD who had been treated by DES were collected and reviewed,and Syntax scores were calculated to valuate the risk stratification.The major adverse cardiac cerebral events（MACCE） were recorded,including all-cause mortality,myocardial infraction,cerebrovascular events and target vessel revascularization.Results：The average age of 68 patients was（62±10）years old,forty-eight of them were male.Forty-one patients suffered from hypertension;twelve patients suffered from type-2 diabetes mellitus.The mean Syntax score was（25.7±9.7）.And the mean follow-up period was（35±16）months.Three patients died from all causes,4 patients had myocardial infraction and 1 received coronary artery bypass grafting（CABG）.Twenty-nine patients were reexamined by coronary angiography,seven of whom had restenosis and received percutaneous coronary intervention（PCI）again.The occurrence of MACCE after 12 months was 15%,and the total MACCE was 22%.MACCE occurrence of the group that had higher Syntax score showed significant difference when compared with the group with lower Syntax score（44% vs15%,P﹤0.05）.Conclusion：DES treatment is valid and safe for patients with ULMCAD,particularly for those who have lower Syntax score.