无保护左主干病变应用药物洗脱支架介入治疗的预后及影响因素分析

目的评价无保护左主干病变应用药物洗脱支架介入治疗的预后及影响因素。方法 45例无保护左主干病变患者接受经皮冠状动脉介入治疗（PCI）,根据病变是否累及左主干远端分叉分组,开口或体部病变为非分叉组（26例）,累及左主干远端或前降支、回旋支开口者为分叉组（19例）。15例患者术中应用血管内超声指导,13例在术后（9.5±6.3）个月进行了冠状动脉造影复查。结果 45例患者经治疗后均达到操作成功标准。术后42例患者获得随访,随访时间13～48个月。分叉组随访期间再发心绞痛率明显高于非分叉组（P〈0.05）,但两组主要心脏不良事件（MACE）发生率比较差异无统计学意义（P〉0.05）。对MACE单因素分析发现,术中血管内超声指导患者MACE发生率明显低于未应用血管内超声指导患者（P〈0.05）。13例术后复查患者4例发生支架内再狭窄,均发生在分叉组,且双支架术再狭窄率明显高于单支架（P〈0.01）。结论经选择的无保护左主干病变药物洗脱支架治疗是可行和安全的,可取得较好的近远期效果,术中应用血管内超声指导可明显减少MACE的发生。

Prognosis and influencing factors of unprotected left main coronary artery intervention with drug-eluting stents

Objective To evaluate the prognosis and influencing factors of unprotected left main coronary artery intervention with drug-eluting stents.Methods We summarized 45 patients underwent unprotected left main coronary artery stenting by percutaneous coronary intervention（PCI）.According to whether the lesions involving the distal left main bifurcation divided into two groups：non-bifurcation lesion group（26 cases）with opening or body disease and bifurcation lesion group（19 cases）with involving the distal left main or anterior descending artery,circumflex openings.There were 15 cases（35.7%） were guided by intravascular ultrasound（IVUS） during PCL,and 13 cases（31.0%） were reviewed by coronary angiography at（9.5±6.3）months after PCI.Results There were 42（93.3%）patients successfully finished the follow-up study for the average of 13-48（19.9±10.2）months.Recurrent angina pectorisin bifurcation lesion group were more than that in non-bifurcation lesion group（33.3%%VS.12.5%,P〈0.05）,but there was no significant difference between those two groups in terms of major adverse cardiac events（MACE）during the follow—up period.Single-variable analysis showed that MACE in IVUS guided PCI was less than that in non-IVUS guided PCI（6.7%VS.18.5%,P〈0.05）,it also presented that the re-stenosis rate in two-stent PCI was higher than that in one-stent PCI（50.0%VS.25.0%,P〈0.01）.Conclusion PCI with DES is safe and feasible for the treatment of selective left main coronary artery disease.it could bring the better short and long-term outcomes.IVUS guided PCI could significantly reduce MACE.