吴雪锋,钱菊英,秦晴

• 1:复旦大学附属中山医院心血管内科上海市心血管病研究所
• 2:粤北人民医院心血管内科

摘要(Abstract)：

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。

关键词(KeyWords)： 冠心病;左主干;分叉病变;药物洗脱支架

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 吴雪锋,钱菊英,秦晴

参考文献(References)：

• [1]Stone PH,Goldschlager N.Left main coronary artery disease:review and appraisal.Cardiovasc Med,1979,4:165-177.
• [2]De Mots H,Rosch J,Mc Anulty JH.Left main coronary artery disease.Cardiovasc Clin,1977,8:201-211.
• [3]Levine GN,Bates ER,Blankenship JC,et al.2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention.A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines and the Society for Cardiovascular Angiography and Interventions.J Am Coll Cardiol,2011,58:44-122.
• [4]Park DW,Kim YH,Yun SC,et al.Long-term outcomes after stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease:10-year results of bare-metal stents and 5-year results of drug-eluting stents from the ASAN-MAIN(ASAN Medical Center-Left MAIN Revascularization)Registry.J Am Coll Cardiol,2010,56:1366-1375.
• [5]Alam M,Huang HD,Shahzad SA,et al.Percutaneous coronary intervention vs.coronary artery bypass graft surgery for unprotected left main coronary artery disease in the drug-eluting stents era--an aggregate data meta-analysis of 11,148 patients.Circ J,2013,77:372-382.
• [6]Athappan G,Patvardhan E,Tuzcu ME,et al.Left main coronary artery stenosis:a meta-analysis of drug-eluting stents versus coronary artery bypass grafting.JACC Cardiovasc Interv,2013,6:1219-1230.
• [7]刘志忠,单守杰,张俊杰,等.第二代药物洗脱支架治疗无保护左主干病变的疗效及安全性分析.中国介入心脏病学杂志,2014,22:702-706.
• [8]Valgimigli M,Malagutti P,Rodriguez-Granillo GA,et al.Distal left main coronary disease is a major predictor of outcome in patients undergoing percutaneous intervention in the drug-eluting stent era:an integrated clinical and angiographic analysis based on the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital(RESEARCH)and Taxus-Stent Evaluated At Rotterdam Cardiology Hospital(T-SEARCH)registries.J Am Coll Cardiol,2006,8:1530-1537.
• [9]Louvard Y,Medina A.Definitions and classifications of bifurcation lesions and treatment.Euro Intervention,2015,19:V23-V26.
• [10]Naganuma T,Chieffo A,Meliga E,et al.Long-term clinical outcomes after percutaneous coronary intervention for ostial/midshaft lesions versus distal bifurcation lesions in unprotected left main coronary artery:the DELTA Registry(drug-eluting stent for left main coronary artery disease):a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment.JACC Cardiovasc Interv,2013,6:1242-1249.
• [11]Chieffo A,Morici N,Maisano F,et al.Percutaneous treatment with drug-eluting stent implantation versus bypass surgery for unprotected left main stenosis:a single-center experience.Circulation,2006,21:2542-2547.
• [12]Price MJ,Cristea E,Sawhney N,et al.Serial angiographic follow-up of sirolimus-eluting stents for unprotected left main coronary artery revascularization.J Am Coll Cardiol,2006,4:871-877.
• [13]Palmerini T,Sangiorgi D,Marzocchi A,et al.Ostial and midshaft lesions vs.bifurcation lesions in 1111 patients with unprotected left main coronary artery stenosis treated with drugeluting stents:results of the survey from the Italian Society of Invasive Cardiology.Eur Heart J,2009,17:2087-2094.
• [14]Rathore S,Terashima M,Katoh O,et al.Predictors of angiographic restenosis after drug eluting stents in the coronary arteries:contemporary practice in real world patients.Euro Intervention,2009,5:349-354.
• [15]Stolker JM,Kennedy KF,Lindsey JB,et al.Predicting restenosis of drug-eluting stents placed in real-world clinical practice:derivation and validation of a risk model from the EVENT registry.Circ Cardiovasc Interv,2010,3:327-334.
• [16]Pei HJ,Sui YG,Wu YJ,et al.Long-term clinical outcomes of patients with unprotected left main bifurcation lesions treated with2-stent techniques.Chin Med J(Engl),2013,126:2409-2413.
• [17]Lee JY,Park DW,Kim YH,et al.Incidence,predictors,treatment,and long-term prognosis of patients with restenosis after drug-eluting stent implantation for unprotected left main coronary artery disease.J Am Coll Cardiol,2011,57:1349-1358.
• [18]Takagi K,Ielasi A,Shannon J,et al.Clinical and procedural predictors of suboptimal outcome after the treatment of drugeluting stent restenosis in the unprotected distal left main stem:the Milan and New-Tokyo(MITO)registry.Circ Cardiovasc Interv,2012,5:491-498.
• [19]Alfonso F,Pérez-Vizcayno MJ,Dutary J,et al.Implantation of a drug-eluting stent with a different drug(switch strategy)in patients with drug-eluting stent restenosis.Results from a prospective multicenter study(RIBS III[Restenosis Intra-Stent:Balloon Angioplasty Versus Drug-Eluting Stent]).JACC Cardiovasc Interv,2012,5:728-737.
• [20]Valgimigli M,Malagutti P,Rodriguez Granillo GA,et al.Singlevessel versus bifurcation stenting for the treatment of distal left main coronary artery disease in the drug-eluting stenting era.Clinical and angiographic insights into the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital(RESEARCH)and Taxus-Stent Evaluated at Rotterdam Cardiology Hospital(TSEARCH)registries.Am Heart J,2006,152:896-902.
• [21]Palmerini T,Marzocchi A,Tamburino C,et al.impact of bifurcation technique on 2-year clinical outcomes in 773 patients with distal unprotected left main coronary artery stenosis treated with drug-eluting stents.Circ Cardiovasc Interv,2008,1:185-192.
• [22]Karrowni W,Makki N,Dhaliwal AS,et al.Single versus double stenting for unprotected left main coronary artery bifurcation lesions:a systematic review and meta-analysis.J Invasive Cardiol,2014,26:229-233.