卢明瑜,叶慧明,王伟民,刘健,赵红,马玉良,李琪,刘传芬

• 1:北京大学人民医院心脏中心
• 2:北京世纪坛医院心血管内科

摘要(Abstract)：

目的探讨药物洗脱支架(DES)在无保护左主干冠状动脉(LMCA)病变的疗效。方法回顾性分析符合条件连续的120例无保护LMCA病变患者行DES的疗效,将其分为分叉病变组(80例)和非分叉病变组(40例)两组,根据病变特点行单支架术或双支架术,分析其支架术的操作特点,住院期间及出院后随访其主要心脏不良事件(MACE,包括死亡、非致死性心肌梗死及靶病变重建)及支架内血栓形成(ST)的情况。结果两组间的临床基线情况差异无统计学意义,共106(88.3%)例患者完成随访,分叉病变组更多使用血管内超声(IVUS)指导治疗(但P>0.05),分叉病变组33例行双支架术,非分叉病变组5例行双支架术(P=0.001),住院期间无MACE及支架内血栓(ST)发生,出院随访平均(26.3±14.5)个月,MACE11例(9.2%),总共死亡3例(2.8%),都是SYNTAX积分及EuroSCORE均属高危的患者,非致死性心肌梗死2例(1.9%),靶病变重建(TLR)6例(5.7%),造影再狭窄6例(占造影随访患者的15.8%),两组ST各1例,两组间MACE差异无统计学意义(7.5%比12.5%,χ2=0.801,P=0.503)。结论在选择性患者行DES治疗无保护LMCA病变不论是否分叉病变近远期的安全性和有效性可以接受。

关键词(KeyWords)： 冠状动脉疾病;血管成形术,经腔,经皮冠状动脉;药物洗脱支架;血栓形成

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 卢明瑜,叶慧明,王伟民,刘健,赵红,马玉良,李琪,刘传芬

参考文献(References)：

• [1]Takaro T,Hultgren HN,Lipton MJ,et al.The VA cooperative randomized study of surgery for coronary arterial occlusive diseaseⅡ.Subgroup with significant left main lesions.Circulation,1976,54:Ⅲ107-Ⅲ117.
• [2]Chieffo A,Stankovic G,Bonizzoni E,et al.Early and mid-term results of drug-eluting stent implantation in unprotected left main.Circulation,2005,111:791-795.
• [3]Park SJ,Kim YH,Lee BK,et al.Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis:comparison with bare metal stent implantation.J Am Coll Cardiol,2005,45:351-356.
• [4]Valgimigli M,van Mieghem CA,Ong AT,et al.Short-and long-term clinical outcome after drug-eluting stent implantation for the percutaneous treatment of left main coronary artery disease:insights from the Rapamycin-Eluting and Taxus Stent Evaluated At Rotterdam Cardiology Hospital registries(RESEARCH and T-SEARCH).Circulation,2005,111:1383-1389.
• [5]Palmerini T,Barlocco F,Santarelli A,et al.A comparison between coronary artery bypass grafting surgery and drug eluting stent for the treatment of unprotected left main coronary artery disease in elderly patients(aged>or=75years).Eur Heart J,2007,28:2714-2719.
• [6]Seung KB,Park DW,Kim YH,et al.Stents versus coronary-artery bypass grafting for left main coronary artery disease.N Engl J Med,2008,358:1781-1792.
• [7]Tamburino C,Di Salvo ME,Capodanno D,et al.Are drug-eluting stents superior to bare-metal stents in patients with unprotected non-bifurcational left main disease-Insights from a multicentre registry.Eur Heart J,2009,30:1171-1179.
• [8]Meliga E,Garcia-Garcia HM,Valgimigli M,et al.Longest available clinical outcomes after drug-eluting stent implantation for unprotected left main coronary artery disease:the DELFT(Drug Eluting stent for LeFT main)Registry.J Am Coll Cardiol,2008,51:2212-2219.
• [9]包哈申,吕昀,柳景华,等.无保护左主干末端病变接受经皮冠状动脉介入治疗或冠状动脉旁路移植术远期效果评价.中国介入心脏病学杂志,2011,19:186-190.
• [10]Serruys PW,Morice MC,Kappetein AP,et al.Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.N Engl J Med,2009,360:961-972.
• [11]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 and5-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.
• [12]Park SJ,Kim YH,Park DW,et al.Randomized trial of stents versus bypass surgery for left main coronary artery disease.N Engl J Med,2011,364:1718-1727.
• [13]Cutlip DE,Windecker S,Mehran R,et al.Clinical end points in coronary stent trials:a case for standardized definitions.Circulation,2007,115:2344-2351.
• [14]Park SJ,Park SW,Hong MK,et al.Stenting of unprotected left main coronary artery stenoses:immediate and late outcomes.J Am Coll Cardiol,1998,31:37-42.
• [15]Chieffo A,Park SJ,Valgimigli M,et al.Favorable long-term outcome after drug-eluting stent implantation in nonbifurcation lesions that involve unprotected left main coronary artery:a multicenter registry.Circulation,2007,116:158-162.
• [16]Pandya SB,Kim YH,Meyers SN,et al.Drug-eluting versus bare-metal stents in unprotected left main coronary artery stenosis a meta-analysis.JACC Cardiovasc Interv,2010,3:602-611.
• [17]Kushner FG,Hand M,Smith SC Jr,et al.2009Focused Updates:ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction(updating the2004Guideline and2007Focused Update)and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention(updating the2005Guideline and2007Focused Update):A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation,2009,120:2271-2306.
• [18]Wijns W,Kolh P,Danchin N,et al.Guidelines on myocardial revascularization:The Task Force on Myocardial Revascularization of the European Society of Cardiology(ESC)and the European Association for Cardio-Thoracic Surgery(EACTS).Eur Heart J,2010,31:2501-2555.
• [19]Valgimigli M,Malagutti P,Rodriguez Granillo GA,et al.Single-vessel 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(T-SEARCH)registries.Am Heart J,2006,152:896-902.
• [20]Palmerini T,Sangiorgi D,Marzocchi A,et al.Ostial and midshaft lesions vs.bifurcation lesions in1111patients with unprotected left main coronary artery stenosis treated with drug-eluting stents:Results of the survey from the Italian Society of Invasive Cardiology.Eur Heart J,2009,30:2087-2094.
• [21]Park SJ,Kim YH,Lee BK,et al.Sirolimus-eluting stent implantation for unprotected left main coronary artery stenosis:Comparison with bare metal stent implantation.J Am Coll Cardiol,2005,45:351-356.
• [22]Valgimigli M,van Mieghem CA,Ong AT,et al.Short-and long-term clinical outcome after drug-eluting stent implantation for the percutaneous treatment of left main coronary artery disease:Insights from the Rapamycin-Eluting and Taxus Stent Evaluated At Rotterdam Cardiology Hospital registries(RESEARCH and T-SEARCH).Circulation,2005,111:1383-1389.
• [23]Nashef SAM,Roques F,Michel P,et al.The EuroSCORE Study Group.European System for,Cardiac Operative Risk Evaluation(EuroSCORE).Eur J Cardiothorac Surg,1999,16:9-13.
• [24]Capodanno D,Miano M,Cincotta G,et al.EuroSCORE refines the predictive ability of SYNTAX score in patients undergoing left main percutaneous coronary intervention.Am Heart J,2010,159:103-109.
• [25]Garg S,Stone GW,Kappetein AP,et al.clinical and angiographic risk assessment in patients with left main stem lesions.JACC Cardiovasc Interv,2010,3:891-901.
• [26]Capodanno D,Caggegi A,Miano M,et al.Global Risk Classification and Clinical SYNTAX(Synergy between Percutaneous Coronary Intervention with TAXUS)and Cardiac Surgery Score in Patients Undergoing Percutaneous or Surgical Left Main Revascularization.JACC Cardiovasc Interv,2011,4:287-297.