药物洗脱支架与冠状动脉旁路移植术治疗无保护左主干病变的临床疗效对比

Clinic comparison of drug-eluting stent(DES) implantation and coronaryartery bypass grafting(CABG) treatment for patients withunprotected left main coronary stenosis

目的:评估药物洗脱支架(DES)置入与冠状动脉旁路移植术(CABG)治疗无保护左主干病变的临床疗效。方法:分析2003-10-2010-09期间行血运重建的282例无保护左主干患者的临床资料,其中接受DES者143例(DES组),接受CABG者139例(CABG组),比较2组住院期和随访期心脑血管不良事件(死亡、非致死性心肌梗死、脑卒中和再次血运重建,即MACCE)的发生情况。结果:DES组手术成功率为100%,住院期间1例发生非致死性心肌梗死,无一例死亡、脑血管意外或需再次血运重建;CABG组手术成功率为95.7%,住院期间有1例发生非致死性急性心肌梗死,无一例需再次血运重建,共有6例死亡;CABG组住院期死亡率明显高于DES组(4.3%∶0,P<0.05),住院期CABG组总MACCE发生率也明显高于DES组(5.0%∶0.7%,P<0.05);随访期平均(17±8)个月,DES组临床心绞痛复发率和再次血运重建率较CABG组有增高趋势(7.8%∶2.7%,7.0%∶1.8%),但差异无统计学意义,其总MACCE发生率显著高于CABG组(14.8%∶7.1%,P<0.05);剔除新发病变及病变进展病例后,2组总MACCE发生率(7.8%∶7.1%)差异无统计学意义。结论:DES治疗无保护左主干病变安全和有效,可以作为CABG的一种替代治疗手段。

Objective：To evaluate the clinical efficacy of drug-eluting stent（DES） implantation and coronary artery bypass grafting（CABG） treatment for patients with unprotected left main coronary stenosis. Method：Two hundred and eighty-two patients with unprotected left main coronary stenosis underwent revascularization from October 2003 to September 2010,of which 143 by percutaneous coronary intervention with DES（DES group） and 139 by CABG（CABG groups）.The incidences of major adverse cardiovascular and cerebrovascular events（MACCE）,which included any death,non fatal myocardial infarction,target vessel revascularization and cerebro vascular event during hospital and follow-up,were compared between 2 groups. Result：The success rate achieved in DES group was 100%,and there was 1 case occurred with non-fatal myocardial infarction,no case of death,cerebral vascular accident or need to repeat revascularization during hospitalization.The success rate achieved in CABG was 95.7%,and there was 1 case occurred non-fatal acute myocardial infarction.No case needed with repeat revascularization,and 6 cases were dead during hospitalization.Hospital mortality was significantly higher in CABG group than DES group（4.3% vs 0%,P〈0.05）.MACCEs during hospitalization in CABG group was significantly higher than in DES group（5.0% vs 0.7%,P〈0.05）.Patients were followed up clinically for a mean of（17±8） months.Compared with CABG group,the rates of clinical angina recurrence（7.8% vs 2.7%） and repeat revascularization in DES group（7.0% vs 1.8%） tended to increase without statistically significant.The incidence of MACCEs was significantly higher in DES group than CABG group（14.8% vs 7.1%）.If remove the cases of new lesions and lesion progressed,the 2 groups had no significant overall difference in incidence of MACCE（7.8% vs 7.1%）. Conclusion：DES is safe and effective in treating patients with unprotected left main coronary stenosis,and it might to be an altertive treatment for CABG.