经桡动脉途径行左主干介入治疗的有效性与安全性研究

The efficacy and safety of percutaneous coronary intervention for left main coronary artery by transradial approach

目的:探讨经桡动脉途径行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)治疗的左主干病变的有效性及安全性。方法:选择2008年1月1日至2010年12月31日间,在我院经桡动脉途径使用6F指引导管行PCI治疗的左主干病变93例患者。记录患者住院期间和随访期间的全因病死率及症状驱动的左主干血运重建率。结果:男性占62.4%,平均年龄(62.5±15.47)岁。左主干病变狭窄程度(76.4±17.63)%,单纯开口部病变18.3%,单纯体部病变11.8%,累及远端分叉病变69.9%,Syntax积分为(23.5±12.33)分。均成功置入支架,共124枚药物洗脱支架(DES),平均直径(3.43±0.48)mm,平均长度(18.3±10.48)mm,单支架术39.8%,双支架技术共60.2%。住院期间无死亡病例。93例患者平均随访23.5个月,随访率100%,随访期间病死率3.2%。随访过程中Syntax评分低危组的患者发生终点事件的比例(4.9%)显著低于高危组(11.9%),差异具有统计学意义(P<0.001)。结论:经桡动脉6F指引导管处理左主干病变安全可行,能取得良好的近远期效果,其中Syntax评分<33分的患者预后更好。

Objective：To evaluate the efficacy and safety of percutaneous coronary intervention（PCI）for left main coronary artery via 6F guiding catheter by transradial approach.Methods： A total of 93 patients with left main lesions receiving PCI via 6F guiding catheter by transradial approach were enrolled consecutively from Jan.1st,2008 to Dec.31st,2010.The primary endpoints included all-cause mortality and symptom-derived target vessel revascularization（TVR）.Results： Male patients accounted for 62.4% of the cohort,and the mean age was（62.5±15.47）.The stenosis severity of left main was（76.4±17.63）%.The left main ostial,shaft and bifurcation lesions accounted for 18.3%,11.8% and 69.9%of the cohort,respectively.The mean Syntax score was（23.5±12.33）.All patients were stented successfully and 124 drug eluting stents were implanted.The mean diameter of the stents was（3.43±0.48）mm and mean length was（18.3±10.48）mm.There were 39.8% patients received single stent implantation and the others received double stents implantation.There were no patients died in hospital.All patients were followed up for（23.5±18.60）months with the all-cause mortality of 3.2%.The primary endpoints incidence in patients with Syntax score 33（4.9%） was significantly lower than those with Syntax score ≥33（11.9%,P 0.001）.Conclusion： PCI for left main lesions via 6F guiding catheter by transradial approach is safe and feasible with good short-and long-term outcomes.And the prognosis in patients with Syntax score less than 33 is better than the others.