刘志忠,单守杰,张俊杰,田乃亮,叶飞,林松,陈绍良

• 1:南京医科大学附属南京医院(南京市第一医院)心血管内科
• 2:南京市心血管病医院

摘要(Abstract)：

目的探讨第二代药物洗脱支架(DES)置入治疗无保护左主干(ULM)病变患者的疗效及安全性。方法回顾性研究南京医科大学附属南京医院诊断为ULM病变并接受DES治疗的患者216例。接受第一代DES的患者121例为F组,接受第二代DES的患者95例为S组。患者术后常规服用阿司匹林100 mg,每日一次;氯吡格雷150 mg,每日一次(维持至少1年)。主要研究终点为主要不良心血管事件(MACE),包括心源性死亡、非致死性心肌梗死和再次靶血管血运重建(TVR);次要终点为12个月时定量冠状动脉造影(CAG)参数。结果在(342±23)d随访期内,总体复合MACE 22例(10.2%),主要构成为TVR 16例(7.4%)。S组复合MACE为5.3%显著低于F组14.0%(χ2=4.491,P=0.034,RR 2.669,95%CI 1.022~6.975)。S组复合MACE的减少主要表现为TVR减少(χ2=4.465,P=0.035,RR 3.402,95%CI 0.998~11.60)。随访血管造影再狭窄F组与S组分别为17例(14.5%)和8例(8.4%),差异无统计学意义(χ2=1.647,P=0.199)。血管内超声提示的晚期获得性支架贴壁不良于F组和S组分别为7例(5.8%)和1例(1.1%),F组有增加趋势,但差异无统计学意义(χ2=3.342,P=0.068)。结论与第一代DES相比较,使用第二代DES治疗ULM病变MACE发生率低,主要表现为TVR减少;第二代DES治疗ULM病变具有更好的疗效和安全性。

关键词(KeyWords)： 无保护左主干病变;血管成形术;药物洗脱支架

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘志忠,单守杰,张俊杰,田乃亮,叶飞,林松,陈绍良

参考文献(References)：

• [1]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.
• [2]Morice MC,Serruys PW,Kappetein AP,et al.Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial.Circulation,2014,129:2388-2394.
• [3]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.
• [4]Stone GW,Moses JW,Ellis SG,et al.Safety and efficacy of sirolimus-and paclitaxel-eluting coronary stents.N Engl J Med,2007,356:998-1008.
• [5]Rasmussen K,Maeng M,Kaltoft A,et al.Efficacy and safety of zotarolimus-eluting and sirolimus-eluting coronary stents in routine clinical care(SORT OUTⅢ):a randomised controlled superiority trial.Lancet,2010,375:1090-1099.
• [6]Almudarra SS,Gale CP,Baxter PD,et al.Comparative outcomes after unprotected left main stem percutaneous coronary intervention:a national linked cohort study of 5,065 acute and elective cases from the BCIS Registry(British Cardiovascular Intervention Society).JACC Cardiovasc Interv,2014,7:717-730.
• [7]Bernelli C,Chieffo A,Buchanan GL,et al.New-generation drugeluting stent experience in the percutaneous treatment of unprotected left main coronary artery disease:the NEST registry.J Invasive Cardiol,2013,25:269-275.
• [8]Kim YH,Park DW,Ahn JM,et al.Everolimus-eluting stent implantation for unprotected left main coronary artery stenosis.The PRECOMBAT-2(Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease)study.JACC Cardiovasc Interv,2012,5:708-717.
• [9]Mehilli J,Richardt G,Valgimigli M,et al.Zotarolimus-versus everolimus-eluting stents for unprotected left main coronary artery disease.J Am Coll Cardiol,2013,62:2075-2082.
• [10]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。
• [11]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.
• [12]Ferrarello S,Costopoulos C,Latib A,et al.The role of everolimuseluting and resolute zotarolimus-eluting stents in the treatment of coronary bifurcations.J Invasive Cardiol,2013,25:436-440.
• [13]Biondi-Zoccai GG,Lotrionte M,Moretti C,et al.A collaborative systematic review and meta-analysis on 1278 patients undergoing percutaneous drug-eluting stenting for unprotected left main coronary artery disease.Am Heart J,2008,155:274-283.
• [14]Park KW,Lim WH,Ahn HS,et al.Everolimus-versus sirolimuseluting stents for the treatment of unprotected left main coronary artery stenosis(results from the EXCELLENT registry).Int J Cardiol,2013,168:2738-2744.
• [15]Sarno G,Lagerqvist B,Frbert O,et al.Lower risk of stent thrombosis and restenosis with unrestricted use of'newgeneration'drug-eluting stents:a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry(SCAAR).Eur Heart J,2012,33:606-613.
• [16]Chen SL,Xu B,Han YL,et al.Comparison of double kissing crush versus Culotte stenting for unprotected distal left main bifurcation lesions:results from a multicenter,randomized,prospective DKCRUSH-Ⅲstudy.J Am Coll Cardiol,2013,61:1482-1488.