80岁及以上患者无保护左主干病变介入治疗病例分析

A case study of percutaneous coronary intervention for the treatment of unprotected left main coronary artery in octogenarians

目的回顾性分析80岁及以上患者无保护左主干病变患者的临床治疗情况，观察手术的安全性、有效性，近期疗效。方法收集80岁及以上无保护左主干患者的临床资料，手术操作、手术前后的临床与影像学结果及住院和出院1年随访期间的主要心脏不良事件的发生情况。结果36例无保护左主干患者纳入研究，病变累及开口6例、体部10例、口部＋体部3例、末端分支14例、左主干全程3例。所有病例成功完成经皮冠状动脉支架术，不完全血运重建35例，完全血运重建1例。在1年随访期间，1例患者术后2个月支架内再狭窄，再次药物支架置人，1年时仍有心绞痛发作；其余35例患者无心绞痛发作，无一0血管事件发生。结论对于不愿行冠状动脉旁路移植术或有手术禁忌的80岁及以上无保护左主干病变患者，支架置人可能是相对安全选择。

Objective To retrospectively analyze the safety and short-term efficacy of percutaneous coronary intervention in octogenarians （aged ~ 80 years） with unprotected left main coronary artery disease （ULMCA） . Methods Clinical data of octogenarians with ULMCA undergoing stent implantation were selected. Clinical and radiographic outcomes before and after treatment, and major adverse cardiac events （MACE） during admission and one year follow up period were collected. Results A total of 36 octogenarians with ULMCA undergoing percutaneous coronary intervention （PCI） were enrolled in this study. Lesions involved ostium （6 cases）, shaft （10 cases）, both ostium and bifurcation （3 cases）, bifurcation （14 cases） and diffuse （3 cases）. All patients successfully received stent implantation, with incomplete reconstruction of blood supply in 35 cases and complete reconstruction of blood supply in 1 case. During a one year follow-up period, recurrent angina pectoris was noted in one patient 2 months after PCI, and angina pectoris remained after re-stent within one year. No angina pectoris and MACE occurred in the other 35 patients. Conclusions Stent implantation may be relatively safely for the treatment of ULMCA in octogenarians who refuse or are unsuitable for coronary artery bypass grafting.