老年患者无保护左主干病变介入治疗临床分析

Interventional therapy of unprotected left main coronary artery lesion in the elderly patients

目的比较分析老年无保护左主干病变(unprotected left main coronary artery,ULMCAD)经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)与冠状动脉旁路移植手术(cononary artery bypass graft,CABG)的临床疗效。方法老年ULMCAD患者190例分为PCI组106例,CABG组84例。比较2组冠状动脉病变特点及术后24个月靶血管重建术、非致命性心肌梗死以及死亡等主要心血管不良事件发生情况。结果 CABG组左主干合并多支病变发生率(94.05%)、合并分叉病变发生率(42.86%)和Syntax积分[(24.95±5.17)分]高于PCI组[78.30%、19.81%、(18.76±6.26)分](P<0.05);随访24个月,PCI组病死率(7.55%)、非致死性心肌梗死发生率(4.72%)、靶血管重建率(9.43%)与CABG组(5.95%、7.14%、5.95%)比较差异无统计学意义(P>0.05)。结论 PCI治疗老年ULMCAD安全、有效,与CABG相比并不增加心血管事件发生率。

Objective To explore the clinical outcomes of percutaneous coronary intervention （PCI） versus coronary artery bypass graft （CABG） for the elderly patients with unprotected left main coronary artery disease （ULMCAD）. Methods In 190 elderly patients with ULMCAD, 106 underwent PCI （PCI group） and 84 underwent CABG （CABG group）. The characteristics of ULMCAD, and the incidences of target vessel revascularization, nonfatal myocardial infarction and death were recorded and compared between two groups in 24 months after operation. Results The incidence of ULMCAD complicated with multi-vessel disease （94.05 %）, the incidence of ULMCAD complicated with branch disease （42. 86%） and Syntax score （24. 95 ± 5. 17） were higher in CABG group than those in PCI group （78.30%, 19.81%, 18. 76±6.26） （P〈0.05）. There were no significant differences in the fatality （7.55% vs 5.95%）, the incidence of nonfatal myocardial infarction （4.72 % vs 7.14% ） and target vessel revascularization （9.43 % vs 5.95 %） between PCI group and CABG group （P〈0.05） after 24-month follow-up. Conclusion PCI is safe and effective for ULMCAD in the elderly patients without increasing the risk of major adverse cardiac events in comparison with CABG.