无保护左主干病变经皮冠状动脉介入治疗的近期和远期疗效

目的　探讨无保护左主干病变 (UPLMT)经皮冠状动脉介入治疗 (PCI)的近、远期疗效。方法　自 1992年 12月至 2 0 0 2年 12月期间 ,对 174例UPLMT行PCI,其中定向斑块旋切术 (DCA) 12 1例 ,支架术 5 3例。其中 85例被列为不能耐受冠状动脉旁路移植术 (CABG)或外科手术高危。术后半年内每月至少门诊复查一次 ,以后定期随诊、电话随访。术后 3、6、12月行冠状动脉造影复查。结果　PCI术均获血管造影成功。住院期间主要不良心脏事件 (MACE) 16例 (9 2 % ) ,15 8例 (90 8% )获操作成功。术后半年随访发现死亡 17例 (9 8% ) ;其中心源性死亡 8例 (4 6 % ) ,均发生于不能耐受CABG或外科手术高危组。半年内有 15 2例患者接受冠状动脉造影复查 ,其中有 36例 (2 3 7% )行血管重建。Kaplan Meier生存分析显示 :PCI术后 1年、3年生存率 (免于死亡 )分别为 89 7%、84 5 % ,术后 1年、3年免于心脏事件的生存率分别为 6 3 8%、5 7 5 %。结论　对UPLMT ,尤其是开口部、体部病变 ,PCI的近期疗效可以接受 ,但术后主要心脏事件 (如血管重建、心肌梗死、死亡等 )有待进一步减少。

Immediate and long-term results of percutaneous coronary intervention for unprotected left main coronary artery stenoses

Objective To evaluate the immediate and late outcomes after percutaneous coronary intervetion (PCI) for unprotected left main coronary artery (LMCA) stenoses. Methods Between December 1992 and December 2002, directional coronary atherectomy (DCA) and/or stenting were performed for unprotected LMCA stenoses in 174 patients (121 DCA, 53 stenting procedures), including 85 patients clarified as coronary artery bypass grafting (CABG) ineligible or at high surgical risk. Clinical follow-up examinations were conducted on an outpatient basis at least once a month in the first 6-month after the procedure, and by regular visits or phone contact later. Follow-up coronary angiography was requested 3, 6 and 12 months after initial PCI. Results Procedural success was achieved in 158 patients (90.8%). In the 6-month follow-up, all-cause mortality was 9.8% (17/174); Cardiac mortality was 4.6% (8/174) and all cardiac deaths occurred in patients at high surgical risks; Target lesion revascularization (TLR) was performed in 34 of the 152 (22.4%) patients after angiography; The estimated cardiac death-free, death-free, cardiac event-free survival were 95.4%, 89.7%, 63.8% one year after PCI; 94.3%, 85.6%, 59.8% two year after PCI; and 94.3%, 84.5%, 57.5% three year after PCI, respectively. Conclusion PCI is feasible for unprotected LMCA disease, especially for ostial and mid-shaft lesions. Despite acceptable immediate results, major adverse cardiac events after PCI remain to be an unresolved issue.