左冠状动脉主干狭窄的临床分析

Clinical Analysis of Left Main Coronary Artery Stenosis

目的 :探讨左主干狭窄的临床特点和治疗方法。方法 :分析左主干病变 (狭窄≥50% )者和非左主干病变者临床资料。结果 :1275例确诊的冠心病患者中 ,左主干狭窄74例 (5 8 % ) ,非左主干病变180例 (14 1% )。左主干合并3支病变占66 2% ,左主干病变组心绞痛发生率较非左主干病变组高。57例 (77 0% )胸痛发作时心电图ST段下移≥0 2mV。左主干并3支组与单纯左主干组比较心肌梗死发生率高 (P<0.05) ,左室射血分数低 (P<0.01)。23例行CABG1年内心绞痛症状消失或明显减轻 ,3例行无保护左主干直接支架术 ,术后半年心绞痛明显减轻。结论 :左主干狭窄者多合并其它冠脉病变 ,心绞痛严重。

Objective:To study the clinical feature and treatment in patients with left main coronary artery(LM)stenosis.Methods:Data of74patients with LM lesion(stenosis≥50%)and180patients with coronary heart disease(CHD)without LM lesion were analyzed.Results:The incidence of LM stenosis was5.8%.The patients with LM stenosis accompanied by3branch lesion of coronary artery was66.2%.The incidence of unstable angina with LM stenosis was higher than that without LM lesion.Marked ST segment depression(≥0.2mV)was found in57(77.0%)patients with LM lesion during the episodes of angina.In LM stenosis with3 branch lesion group,the incidence of myocardial infarction was higher(P<0.05),and LVEF was lower(P<0.01)compared with that in isolated LM group.The coronary artery by graft(CABG)was performed in23patients,and the severe angina disappeared or remitted during one year.The stent of unprotected left main coronary artery was performed in3patients,and the angina remitted in6months.Conclusion:The patients with LM stenosis have severe angina pectoris,most of them are accompanied by other vessel lesions.CABG is the best therapy.