药物洗脱支架治疗无保护左主干远端分叉病变的长期预后

Long-term outcomes of drug-eluting stents implanted in distal unprotected left main coronary artery lesions

目的评估使用药物洗脱支架（drug-eluting stents,DES）治疗无保护左主干（unprotected left main coronary artery,ULMCA）远端分叉病变的长期预后。方法回顾性入选2005年1月至2009年12月因ULMCA远端分叉病变行DES置入的111例患者。以随访过程中发生的主要不良心脑血管事件（major adverse cardiac and cerebrovascular event,MACCE）作为研究终点,包括死亡、非致死性心肌梗死、脑血管意外以及靶病变血运重建（target lesion revascularization,TLR）。结果 111例患者的平均年龄为（65.6±10）岁,其中24例（21.6%）合并糖尿病,35例（31.5%）左主干分叉病变为Medina 1,1,1型,88例（79.3%）接受必要时T支架术。中位随访时间为2.3年,随访过程中34例（30.6%）复查冠状动脉造影。无MACCE事件的生存率为87.4%,无TLR的生存率为94.6%,糖尿病是TLR的独立预测因素（OR 2.62,95%CI 1.12~1.62,P=0.004）。结论使用DES治疗ULMCA远端分叉病变是安全并且有效的。

Objective To evaluate the long-term clinical outcome of percutaneous coronary intervention（ PCI） with drug-eluting stents（ DES） for distal unprotected left main coronary artery（ ULMCA） lesions. Methods Between Jan 2005 and Dec 2009,111 patients with distal ULMCA disease who underwent drug-eluting stents implantation were enrolled in this retrospective study. The primary end points were major adverse cardiac and cerebrovascular event（ MACCE） at follow-up,including death,nonfatal myocardial infarction,cerebrovascular event and target lesion revascularization（ TLR）. Results Patients were 65. 6 ± 10 years old. 21. 6% were diabetic. 31. 5% of the left main bifurcations were classed as Medina 1,1,1. Provisional T stent technique was performed for 79. 3% of the population. 30. 6% of cases underwent angiography follow-up. The median follow-up time was 2. 3 years,the MACCE-free survival was 87. 4% and the estimated freedom from TLR was 94. 6%. Diabetes mellitus was identified as the predictor of TLR. Conclusions PCI with DES for distal ULMCA disease was safe and effective when the strategy was made based on the case-by-case assessment.