不同治疗策略在老年无保护左主干冠状动脉病变中作用

Application of two different measures in the elderly with unprotected left main coronary artery disease

目的探讨行置入药物洗脱支架术(drug-eluting stent,DES)及冠状动脉搭桥术(coronary artery bypass grafting,CABG)治疗老年无保护左主干(unprotected left main artery,ULM)冠状动脉病变患者的临床特点及预后。方法比较行DES治疗的111例(DES组)和行CABG治疗的119例(CABG组)老年ULM病变患者的临床特点、冠状动脉病变及远期临床预后。结果 DES组患糖尿病比例(40.5%)高于CABG组(21.8%)(P<0.05);CABG组左室射血分数(57.82±11.50)明显低于DES组(63.34±8.85)(P<0.01);CABG组合并多支病变者比例(68.1%)高于DES组(26.1%)(P<0.01);DES组远期靶血管再次血运重建比例(10.8%)高于CABG组(3.4%)(P>0.05);2组远期心脑血管事件、总死亡、心源性死亡、脑血管事件、心肌梗死事件发生率比较差异无统计学意义(P>0.05)。结论与CABG术比较,DES术可增加老年ULM冠状动脉病变患者远期再次血运重建,不增加心、脑血管事件发生率及病死率。

Objective To explore the clinical characteristics and prognosis of the elderly patients with unprotected left main coronary artery disease treated with coronary artery bypass grafting （CABG）F or drug-eluting stent （DES）. Methods The clinical characteristics, diseased coronary arteries and long-term prognosis of elderly unprotected left main coronary artery disease were compared between 111 patients receiving DES （DES group） and 119 receiving CABG （CABG group）. Results The incidence of diabetes mellitus was higher in DES group （40. 5%） than that in CABG group （21.8%） （P〈0.05）, and the left ventricular ejection fraction was lower in CABG group （57.82±21.50） than that in DES group （63.34±8.85） （P〈0.01）. The incidence of multivessel disease was higher in CABG group （68. 1%） than that in DES group （26.1%） （P〈0.01）. Target vascular reconstruction was more frequent in DES group （10.8%） than that in GABG group （3.4%） （P〈0.05）. There were no significant differences in long-term major adverse cardiac and cerebral events, total fatality rate, rate of cardiac death and myocardial infarction between two groups （P〉0.05）. Conclusion DES may improve target vascular reconstruction in the elderly patients with unprotected left main artery disease, and does not increase the incidence of major adverse cardiac and cerebral events and the fatality rate.