前降支开口病变经皮冠状动脉介入治疗两种不同术式的临床结果观察

The clinical observation of two different percutaneous coronary intervention methods in coronary ostial lesions in the anterior descending coronary artery

目的评价冠状动脉前降支开口病变采用两种不同术式的临床疗效及安全性。方法入选2009年10月至2010年10月在广东医学院附属医院住院的患者87例,其中男66例,女21例,年龄41～75岁,平均(61.9±8)岁,随机分为A、B两组,A组(cross-over术)44例和B组(前降支支架精确定位术)43例;观察两组间即刻手术成功率、手术对比剂总量、手术操作时间、手术安全性,并且术后临床随访1、3、6、12、18个月,6～12个月复查冠状动脉造影(CAG),观察终点事件主要心脏不良事件(MACE)和支架内再狭窄发生率。结果 A、B两组手术全部成功,但A组的对比剂总量和经皮冠状动脉介入治疗(PCI)耗时明显比B组少。术后住院期间两组肌钙蛋白I指标相比较,A组明显优于B组;在TIMI血流,A组的前降支有更好的冠状动脉血流灌注趋势。随访18个月结束时,A、B两组总的终点事件MACE的发生率分别为4.5%和18.6%,差异有统计学意义(P<0.05),其中心功能不全(NYHAⅢ～Ⅳ级)、心绞痛发生、PCI术后再发心肌梗死、再住院的发生率差异有统计学意义(P<0.05),PCI术后再发心肌梗死的发生率及心源性死亡均无统计学意义。结论前降支开口病变行cross-over术较精确定位术相比更为简便、安全,远期临床疗效也更为优越。

Objective The aim of our study is to assess the clinical effect and safety of two different percutaneous coronary intervention （PCI） methods in transradial intervention （TRI） of coronary ostial lesions in the anterior descending coronary artery （LAD）. Methods 87 patients with transradial intervention （TRI） of coronary ostial lesions in the anterior descending coronary artery （LAD） selected from October 2009 to October 2010, among whom 66 are males and 21 are females, with age of 41 - 75 years old and mean age of （61.9 ±8. 3）years old, who are randomly classified into two groups： Group A and Group B. Group A（cross-over） including 44 cases and Group B （anterior descending support accurate positioning technique ） including 43 cases. The immediate operation success rate between two groups, amount of contrast agent, operation time, operation safety were observed. The 1st, 3rd, 6th, 12th, and 18th months after operation are follow-up window period and CAG was reviewed in 6 to 12 months, observing the major adverse cardiac events and the incidence of restenosis. Results Compared Group A with Group B： 1. The procedural success rate was 100% in both groups, but the total amount of contrast media used [ （91 ± 12） ml vs. （ 186 ± 17） ml, P 〈 0. 05 ] and the time consumed [ （31 ± 6） min vs. （50 ± 11 ） min, P 〈 0. 05 ] by Group A are obviously less than that by Group B. 2. The postoperative hospital stay in troponin index of Group A was better than Group B, and in the TIMI flow of group A, the blood perfusion of LAD have a better trend. 3. During the follow-up of 18 months,there were no cardiac death in the two groups. Among them, end point events including cardiac insufficiency （NYHA Ill to IV ）, occurance of angina pectoris, revascularization rate and the re-hospitalization was statistically different （P 〈 O. 05 ）. There was no difference in the re-AMI rate pest PCI. Conclusions Compared with stent accurate positioning technique, cross-over operation is simpler and safer with compatible long term clinical efficacy.