魏敬飞,鄢华,宋丹,彭剑,郭卉,汪敏,苏晞

• 1:武汉亚洲心脏病医院心内科

摘要(Abstract)：

目的对比分析国产西罗莫司洗脱支架(Firebird支架)和进口佐他莫司洗脱支架(Resolute支架)治疗冠心病无保护左主干(ULMCA)病变患者的临床疗效和安全性。方法回顾性分析2011年1月至2013年12月在武汉亚洲心脏病医院行血管内超声(IVUS)指导下的经皮冠状动脉介入治疗(PCI)的ULMCA病变患者76例,根据术中所用支架分为两组:进口佐他莫司洗脱支架组(Resolute组,34例)和国产西罗莫司洗脱支架组(Firebird组,42例),比较两组患者的一般资料、冠状动脉病变特点、手术策略以及术后左心室射血分数(LVEF)的变化,随访观察患者远期预后。结果Resolute组冠状动脉病变累及左主干末端的比例高于Firebird组[27例(79.4%)比19例(45.2%),P<0.05],采用双支架置入策略的比例高于Firebird组[10例(29.4%)比3例(7.1%),P<0.05]。两组患者术前、术后3个月LVEF分别比较,差异均无统计学意义(均P>0.05)。平均随访(23.3±10.7)个月,两组主要不良心脑血管事件(MACCE)[2例(5.9%)比3例(7.1%),P=1.000]及再发心绞痛[4例(11.8%)比5例(11.9%),P=1.000]的发生率分别比较,差异均无统计学意义。结论与进口佐他莫司洗脱支架相比,国产西罗莫司洗脱支架用于治疗ULMCA病变也是安全、有效的,两种支架治疗ULMCA病变的远期预后相似。

关键词(KeyWords)： 左主干病变;药物洗脱支架;西罗莫司;佐他莫司;血管内超声

Abstract:

Keywords:

基金项目(Foundation): 2012年度武汉市卫计委临床医学科研项目(WX12C41);; 2013—2014年度湖北省卫生厅青年科技人才项目(QJX2012-35)

作者(Author): 魏敬飞,鄢华,宋丹,彭剑,郭卉,汪敏,苏晞

参考文献(References)：

• [1]De la Torre Hernandez JM,Alfonso F,Sanchez Recalde A,et al.Comparison of paclitaxel-eluting stents(Taxus)and everolimus-eluting stents(Xience)in left main coronary artery disease with 3 years follow-up(from the ESTROFA-LM registry)..Am J Cardiol,2013,111:676-683.
• [2]Bernelli C.Drug-eluting stents in unprotected left main coronary artery disease.Expert Rev Cardiovasc Ther,2014,12:1349-1368.
• [3]Conrotto F,Scacciatella P,D'Ascenzo F,et al.Long-term outcomes of percutaneous coronary interventions or coronary artery bypass grafting for left main coronary artery disease in octogenarians(from a drug-eluting stent for left main artery registry substudy).Am J Cardiol,2014,113:2007-2012.
• [4]Naganuma T,Chieffo A,Takagi K,et al.First generation versus new generation drug-eluting stents for the treatment of ostial/midshaft lesions in unprotected left main coronary artery:The Milan and New-Tokyo(MITO)registry.Catheter Cardiovasc Interv,2015,85:E63-E69.
• [5]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.
• [6]Hillis LD,Smith PK,Anderson JL,et al.2011 ACCF/AHA guideline for coronary artery bypass graft surgery:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation,2011,124:2610-2642.
• [7]Kolh P,Wijns W,Danchin N,et al.Guidelines on myocardial revascularization.Eur J Cardiothorac Surg,2010,38:S1-S52.
• [8]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.
• [9]Naganuma T,Chieffo A,Meliga E,et al.Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry:a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment.JACC Cardiovasc Interv,2014,7:354-361.
• [10]Puri R,Kapadia SR,Nicholls SJ,et al.Optimizing outcomes during left main percutaneous coronary intervention with intravascular ultrasound and fractional flow reserve:the current state of evidence.JACC Cardiovasc Interv J,2012,5:697-707.
• [11]刘健,王昭,王伟民,等.整合血管内超声和血流储备分数指导左主干分叉病变单支架"骑跨"技术的研究.中国介入心脏病学杂志,2014,22:225-229.
• [12]Higami H,Shiomi H,Niki S,et al.Long-term clinical outcomes after sirolimus-eluting stent implantation for unprotected left main coronary artery disease.Cardiovasc Interv Ther,2015,30:189-197.
• [13]卢明瑜,叶慧明,王伟民,等.120例无保护左主干冠状动脉病变药物洗脱支架术的临床疗效和随访研究.中国介入心脏病学杂志,2012,20:32-37.