无保护左主干开口/体部病变患者血运重建术的长期预后

Long-term Prognosis of Revascularization in Patients With Ostial/shaft Lesions of Unprotected Left Main Coronary Artery(ULMCA)

目的:本研究旨在比较无保护左主干开口/体部病变接受经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)的长期预后。方法:入选2003-01至2009-07北京安贞医院行PCI或CABG治疗的无保护左主干开口/体部病变259例。其中行PCI(仅置入药物洗脱支架)149例(PCI组),行CABG治疗110例(CABG组)。研究终点包括全因死亡、非致命性心肌梗死、卒中、再次血运重建、心原性死亡/心肌梗死/卒中联合硬终点以及主要不良心脑血管事件(MACCE,包括心原性死亡、非致命性心肌梗死、卒中及再次血运重建的联合终点)。结果:随访时间中位数7.1年(四分位间距5.3,8.2年),在无保护左主干开口/体部病变人群中,校正前PCI组和CABG组两组间全因死亡(12.7%vs 29.7%;P=0.096)、非致命性心肌梗死(14.8%vs 8.5%;P=0.844)、卒中(9.3%vs 6.3%;P=0.904)、再次血运重建(26.8%vs 19.0%;P=0.234)、心原性死亡/心肌梗死/卒中联合硬终点(18.9%vs20.3%;P=0.224)、MACCE(37.5%vs 34.2%;P=0.946)发生率差异均无统计学意义,校正后结果与校正前趋势相同。结论:在最长达8.2年的随访期内,对于无保护左主干开口/体部病变,PCI和CABG具有相当的有效性和安全性。

Objective： To compare the long-term prognosis of percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG） in patients with ostial/shaft lesions of unprotected left main coronary artery （ULMCA）. Methods： A total of 259 patients with isolated ostial/midshaft lesions of ULMCA who received PCI or CABG in our hospital from 2003-01 to 2009-07 were enrolled. The patients were divided into 2 groups： PCI group, n=149 patients who received drug-eluting stents （DES） implantation and CABG group, n=110. The end points were all cause death, myocardial infarction （MI） and major adverse cardiac and cerebrovascular events （MACCE） which included cardiac death, non-fetal MI, stroke, repeated revascularization and the composite events death. Results： The median follow-up period was 7.1 years （inter quartile range 5.3-8.2 years） in all patients. Before multivariate adjusting, the following parameters were similar between PCI group and CABG group： all cause death （12.7% vs 29.7%）, P=0,096; non-fatal M1 （14.8% vs 8.5%）, P=0.844; stroke （9.3% vs 6.3%）, P=0.904; repeated revascularization （26.8% vs 19.0%）, P=0.234; composite events of cardiac death/stroke/MI （18.9% vs 20.3%）, P=0.224 and MACCE occurrence （37.5% vs 34.2%）, P=0.946. With adjusted variations, the trend was similar to pre-adjustment. Conclusion： During the maximum 8.2 years follow-up period, PCI and CABG had the similar efficacy and safety in patients with ostial/shaft lesions of ULMCA.