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目的找出无保护左主干病变植入药物洗脱支架(drug-eluting stent,DES)后发生不良事件的危险因素。方法连续选取165例接受DES治疗的LMCA患者,通过5年临床随访将患者分为无事件组(131例)和终点事件组(34例)。本研究的复合终点包括心性死亡、心肌梗死(myocardial infarction,MI)、靶病变血运重建(target-lesion revascularization,TLR)和支架内血栓(stent thrombosis,ST)。通过Logistic回归分析找出LMCA患者植入DES后发生不良事件的独立危险因素。结果终点事件组患高血压(P=0.046)、糖尿病(P=0.029)及肾功能不全(P=0.049)的患者所占百分比高于无事件组。终点事件组患者的平均血管直径小于无事件组(P=0.047)。随访5年的MI、TLR、心性死亡和支架内血栓发生率分别为5.5%、10.3%、7.3%和5.5%。Logistic回归分析显示:糖尿病(OR=2.86,95%CI:1.08~7.56,P=0.017)和肾功能不全(OR=1.96,95%CI:1.32~2.19,P=0.043)是LMCA患者发生复合终点的独立危险因素,而平均血管直径为其保护因素(OR=0.96,95%CI:0.92~0.99,P=0.035)。结论在无保护LMCA患者中,患有糖尿病及肾功能不全的患者可能会使术后获益减少;左主干病变直径较小的患者可能更适于植入DES。 相似文献
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目的 通过对植入药物洗脱支架的无保护左主干(LMCA)患者随访分析,讨论无保护LMCA患者行药物支架植入术的安全性及有效性.方法 连续入选在中山医院心导管室成功植入药物支架的无保护左主干(LMCA)的患者100例,随访住院期间和出院后有无再发心绞痛和主要心脏不良事件(MACE),出院6~9个月复查冠脉造影判断其有无支架内再狭窄,并对不同病变部位和手术方式患者的MACE发生率进行分组统计分析.结果 住院期间MACE发生率为1%,术后2年时MACE发生率为22%.术后6个月内心绞痛缓解率80.80% (80/99),支架内再狭窄发生率为7.89%.术后2年,非远端病变组与远端病变组的靶血管再次血运重建率(6.52% vs 24.07%,P=0.001)和MACE发生率(8.70% vs 33.33%,P=0.003)比较,前者均低于后者,其差别有显著性,而两组死亡率(0% vs 5.56%,P>0.05)和心肌梗死发生率差异无显著性(2.17% vs 3.70,P>0.05).COX多元回归分析显示只有病变部位是MACE的独立预测因素(beta=-1.541,P=0.005).术后2年内,远端病变组单支架术(n=19)和多支架术(n=35)亚组死亡率(5.26% vs5.71%,P>0.05)、心肌梗死率(5.26% vs 2.86%,P>0.05)、靶血管再次血运重建率(10.53% vs 31.43%,P>0.05)、MACE发生率(21.05% vs 40.00%,P=0.229)均差异无显著性.结论 无保护左主干病变患者选择性的进行PCI安全可行,有良好的近远期效果.左主干远端分叉病变患者的预后较差. 相似文献
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目的:评价药物洗脱支架治疗无保护左主干(LMCA)病变的安全性和临床疗效。方法:回顾性分析2004年1月~2006年12月完成的49例无保护左主干病变药物洗脱支架置入术。结果:49例无保护LMCA病变全部成功置入支架,共置入61枚药物洗脱支架,直接支架置入术10例(20.4%),39例(79.6%)行球囊预扩张后置入支架;远端分叉部位病变双支架置入12例(24.5%)。住院期间死亡2例(4.1%),无其他主要心血管事件发生;44例(89.8%)完成门诊及电话随访,平均随访(14±6)个月,术后6~12个月完成冠脉造影随访16例(32.7%),随访期间3例死亡(6.1%),1例死于脑卒中,2例心原性猝死,分别为术后7个月及12个月。随访期间主要心血管事件发生率为6.1%(3/49)。结论:药物洗脱支架治疗经选择的LMCA病变是安全可行的,有较理想的近期和远期疗效。 相似文献
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药物洗脱支架治疗左主干病变 总被引:1,自引:0,他引:1
冠状动脉搭桥术曾被认为是左主干病变治疗的首选,近年来随着药物洗脱支架的应用和操作技巧、器械的进步,越来越多的临床试验证实药物洗脱支架治疗左主干病变具有完全可行的疗效。现在左主干病变不再是介入治疗的禁忌证。本文从介入治疗左主干病变的适应证,药物洗脱支架及冠状动脉搭桥术治疗左主干病变的疗效对比加以阐述。 相似文献
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目的 评价药物洗脱支架(DES)置入与冠脉旁路移植术(CABG)对冠脉无保护左主干病变患者的近远期疗效.方法 对2003年2月至2008年6月接受治疗的冠脉无保护左主干病变的病人进行评估,其中113例置入了药物洗脱支架(DES组),96例病人接受了冠脉旁路移植术(CABG组).记录患者围手术期,术后6月及3 a不良心脑血管事件(MACCES)发生率.结果 (1)两组患者一般临床特征比较无统计学意义;(2)DES组与CABG组术后12月的MACCES发生率分别为11%及10.6%,P>0.05; (3)平均随访18个月,DES组与CABG组无MACCES生存率比较差异无统计学意义(P>0.05); (4)冠脉造影随访DES组再狭窄率高于CABG组(7.69%比 0%,P<0.05).结论 冠脉无保护左主干病变DES治疗手术成功率高,有较理想的近远期疗效. 相似文献
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目的 回顾性分析冠心病无保护左主干病变(ULMCA)患者使用药物洗脱支架(DES)的经皮冠脉介入治疗(PCI)与冠脉旁路移植手术(CABG)的疗效,探讨ULMCA患者的最佳血运重建策略.方法 本研究回顾性收集了176例从2003年6月至2008年3月在云南省2家医院经PC IDES和CABG治疗的无保护左主干病变患者,其中CABG组80例,PCI-DES组96例.收集患者的基本情况、左主干病变特点、冠脉旁路移植手术和P CI手术情况,随访患者术后3年的主要不良心脑血管事件(MA C CE)的发生率,包括死亡、非致死性心肌梗死、再次血运重建以及脑卒中、脑出血等,以及冠状动脉造影复查情况.结果 1.PCI-DES与CABG两组在性别、年龄、高血压病、糖尿病、左心室射血分数、稳定型心绞痛和不稳定型心绞痛、陈旧性心肌梗塞等基线资料方面相比无显著性差异(P>0.05).2.住院期间P C I-D E S组死亡率为0%,C A B G组为1.25%,CABG组住院期间的MACCE事件发生率较PCI组高.3.术后1年PCI-DES组与CABG组的MACCE发生率分别为12.5%及13.75%,两组无统计学差异(P>0.05),但PCI组靶血管再次血运重建率(TVR)明显高于CABG组.术后3年,DES组与CABG组MACCE发生率比较无显著性差异,而PCI组靶血管再次血运重建率(TVR)仍然高于CA BG组.结论 P C I-D E S与C A BG治疗无保护左主干病变患者,其近、中、远期疗效相似,但PCI-DES组TVR事件发生率高,在不同的患者人群中,应结合临床特征和冠脉病变特点选择恰当的血运重建术. 相似文献
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目的 探讨老年无保护左主干(ULMCA)病变患者介入治疗预后及不良事件危险因素。方法 入选单中心年龄≥60岁行PCI治疗的ULMCA病变患者,收集基线资料并随访。记录随访中发生的主要不良心脑血管事件(MACCE),绘制Kapaln-Meier曲线,并采用Cox回归法分析不良预后的影响因素。结果 共182例完成随访,中位随访时间21.5(13,36.5)个月,无MACCE中位生存时间为66个月。共发生MACCE43例(23.63%),其中死亡12例(6.59%)、非致死性心肌梗死1例(0.55%)、非致死性脑血管意外1例(0.55%)、靶血管血运重建29例(15.93%),72.09%的MACCE发生在术后2年内。多因素校正的Cox回归分析显示:左主干支架直径(HR=0.37,95% CI:0.17~0.82,P=0.014)、分叉部病变(HR=1.92,95% CI:1.01~3.62,P=0.045)、吸烟指数>1000年支(HR=3.78,95% CI:1.29~11.05,P=0.015)是MACCE的独立危险因素;EuroSCORE Ⅱ≥2%(HR=3.96,95% CI:1.15~13.61,P=0.029)是全因死亡的独立危险因素。结论 老年ULMCA病变患者PCI术后总体预后良好,但术后2年内需特别警惕MACCE发生。左主干支架直径较小、左主干分叉部受累、吸烟指数>1000年支、EuroSCORE Ⅱ≥2%者预后较差。 相似文献
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目的:回顾性分析无保护左主干(UPLM)患者的临床治疗情况,观察手术的安全性、有效性,近期疗效。方法:分析40例UPLM患者一般资料、手术操作技巧、手术前后的临床与影像学结果以及住院和出院近期内的主要心脏不良事件的发生情况。结果:所有病例经过经皮冠状动脉支架术(PCI),病变分为开口病变、体部病变、末端分支病变,经过手术治疗,无严重的心脏事件发生。结论:在药物支架逐步成熟的年代以及随着手术医生的手术熟练程度逐步成熟,使曾经是外科治疗的左主干病变通过药物支架获得了良好的近期疗效,近期无心脏严重事件发生。 相似文献
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目的:评价经皮冠状动脉介入治疗(PCI)冠心病无保护左主干病变(ULMCA)的临床疗效.方法:2006年1月~2012年2月共入选32例经皮冠状动脉介入治疗冠心病的患者,年龄33 ~83岁,平均年龄(61.1±12.8)岁,男性24例(75%),有糖尿病者6例(18.8%),有高血压者14例(43.8%),吸烟8例(25%),高血脂10例(31%).分析32例患者临床特征、冠脉造影结果、PCI后即刻效果及随访6~42个月结果.随访终点指标:主要不良心脏事件(MACE)率、再发心绞痛发生率,支架血栓发生率.结果:32例ULMCA患者冠脉介入治疗均获得成功,共植入国产药物洗脱支架48枚.其中左主干开口部狭窄13例(40.6%,13/32),体部狭窄9例(28.1%,9/32),远端分叉部狭窄10例(31.3%,10/32).住院期间死亡率3.1%,随访6~42个月无支架内血栓形成,心绞痛复发率12.5%,靶血管血运重建率(TVR)9.4%,MACE率12.5%.结论:经皮冠状动脉介入治疗冠心病无保护左主干病变是可行和安全的,近期、远期效果良好. 相似文献
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目的分析冠心病无保护左主干病变行经皮冠脉介入治疗术(PCI)的疗效及安全性。方法回顾性总结我院2008年4月-2011年10月共11例无保护左主干病变行经皮冠脉介入治疗术患者的临床资料、疗效、随访结果。结果全部患者PCI成功率100%,术后症状明显改善,均完成12-36个月随访,2例患者复查了冠脉造影,随访期再发心绞痛发生率为0%、急性心肌梗死发生率为0%、靶血管重建发生率为0%,无心源性死亡患者。结论对经过选择的无保护左主干病变患者进行PCI是安全有效的,预后较好。 相似文献
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目的观察无保护左主干(ULM)冠状动脉病变不同治疗策略远期临床效果。方法比较211例冠状动脉内药物洗脱支架置入术(DES)(DES组)和176例冠状动脉搭桥术(CABG)(CABG组)治疗ULM病变后远期主要心脑血管事件(MACCE)发生率。结果 DES组远期再次血运重建率明显高于CABG组,心源性病死率明显低于CABG组(P<0.05)。采用倾向性得分法分析,血运重建方式与远期MACCE、总病死、心源性病死、心肌梗死和脑卒中发生率未见明显相关(P>0.05);DES与远期再次血运重建率明显相关,风险比为3.050,95%可信区间(1.289,7.217),P<0.05。结论与DES比较,CABG治疗的ULM病变患者临床状态更复杂,冠状动脉病变更严重。DES是接受血运重建的ULM病变患者远期再次血运重建的独立预测因子。 相似文献
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无保护左主干病变的介入治疗 总被引:2,自引:0,他引:2
目的:探讨药物支架时代无保护左主干病变介入治疗的疗效及安全性。方法:选择12例无保护左主干病人,开口病变2例,体部病变3例,远段病变4例(均累及前降支,回近支开口),近中段病变1例,左主干整程病变1例。狭窄均≥50%,按标准方法行PCI。结果:手术成功率100%,无严重并发症,心绞痛全部缓解,2例心功能不全病人射血分数提高了10%以上。随访无死亡病例。结论:药物支架置入治疗无保护左主干疗效显著、安全。正确的病例选择、策略选择及操作技巧是成功的关键。 相似文献
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Prognosis of unprotected left main coronary artery stenting and the factors affecting the outcomes in Chinese 总被引:2,自引:3,他引:2
《中华医学杂志(英文版)》2006,119(1):14-20
AT MOST CENTRES UNPROTECTED LEFT MAIN CORONARY ARTERY (LMCA) LESION HAS BEEN CONSIDERED A SUFFICIENT CRITERION FOR CORONARY ARTERY BYPASS GRAFTING (CABG). 1 ALTHOUGH ELECTIVE ANGIOPLASTY OF UNPROTECTED LMCA LESION IS TECHNICALLY FEASIBLE, THE LONG TERM PROGNOSIS HAS BEEN VERY POOR AND THE ACTUARIAL 3 YEAR SURVIVAL ONLY 36%. THEREFORE, ANGIOPLASTY OF UNPROTECTED LMCA IS A CO… 相似文献
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GAO Run-lin XU Bo CHEN Ji-lin HAN Ya-ling LI Zhan-quan Lü Shu-zheng QI Xiao-yong HUO Yong WANG Le-feng CHEN Jun-zhu SHEN Wei-feng FANG Wei-yi JIA San-qing 《中华医学杂志(英文版)》2006,119(1):14-20
Background The long term prognosis of unprotected left main coronary artery (LMCA) stenting is controversial This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes. Methods From May 1997 to March 2003 , 224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis. Results Stents were implanted into LMCA successfully in 223 cases (99.6 %). One death (0.5%) and one case of non-Q wave nonfatal myocardial infarction (MI) occurred in hospital. The mean follow-up time was (15.6 ± 12.3) months. Cardiac death developed in 10 cases (4.5%), noncardiac death in 2 cases (0.9%), nonfatal MI in 4 cases (1.8%), target lesion revascularization (TLR) of LMCA in 26 cases (11.7%) and TLR of nonLMCA in 37 cases (16.5%). Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction (LVEF < 40%), female gender and LMCA combined with multivessel disease; that major adverse cardiac events (MACE) correlated with LVEF < 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF < 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The restenosis rate was 31.4%. Conclusions Long-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF ≥ 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained. 相似文献
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YANG Gui-tang HAN Ya-ling JING Quan-min WANG Shou-li LI Yi MA Ying-yan WANG Geng LUAN Bo WANG Xiao-zeng WANG Bin WANG Zu-lu WANG Dong-mei 《中华医学杂志(英文版)》2010,123(7):816-821
Background The patients with unprotected left main coronary artery (ULMCA) stenosis and chronic total occlusion (CTO) lesions at the left anterior descending (LAD) artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO. Methods From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients (7.7%) refused surgery due to their young age (S40 years), and the other 72 patients (92.3%) were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age (〉80 years), chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCORE ≥6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex. Results Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients (6.4%) experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up ((52±28) months), there were 3 cardiac deaths (3.8%) and 4 (5.1%) nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients (64.1%), and target vessel revascularizations were required in 10 patients (12.8%), among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% (13/78).Conclusions This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above. 相似文献
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【摘要】 目的 探讨行经皮冠状动脉介入(PCI)治疗的未绝经女性冠心病患者的临床特点。方法 回顾性分析2014年1月至2018年12月于解放军总医院第一医学中心行首次PCI治疗的74例未绝经和109例绝经女性冠心病患者的临床资料。比较两组括患者术前一般情况,术中冠脉病变特征,术后1年内的主要心血管不良事件(MACE)发生情况的差异,分析影响术后MACE发生的危险因素。结果 未绝经组患者的高血压病患病率(41.9% vs 72.5%)、吸烟率(0 vs 13.8% )、低密度脂蛋白胆固醇水平(2.40±0.86 vs 2.71±0.95mmol/L)、甘油三酯水平(1.40±0.74 vs 1.69±0.97mmol/L)及总胆固醇水平(3.88±1.02 vs 4.39±1.05mmol/L)均低于绝经组(P均<0.05)。未绝经组患者自身免疫病患病率(14.9% vs 1.8%)、左心室射血分数(62.4±4.9 vs 60.0±5.4 )均高于绝经组(P均<0.05)。未绝经组左前降支(83.8% vs 67.9%)和左主干病变发生率(14.9% vs 4.6%)均高于绝经组(P均<0.05)。未绝经组PCI术后1年内主要不良心血管事件(MACE)的发生率高于绝经组[12.2%(9/74) vs 3.7%(4/109),P<0.05]。多因素logistic回归分析显示,未绝经是女性冠心病患者PCI术后1个内发生MACE的独立危险因素(OR=3.635,95% CI 1.075~12.283,P=0.038)。结论 未绝经女性冠心病患者左前降支和左主干受累较多见,且经PCI治疗后1年内MACE的发生率较高。 相似文献
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Efficacy of stenting for unprotected left main coronary artery disease in 297 patients 总被引:5,自引:0,他引:5
Background Angioplasty in the unprotected left main coronary artery (LMCA) has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent (DES), for treatment of unprotected LMCA disease.
Methods Between September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention (PCI) on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES "'era" (group I, from September 1997 to December 2002) were compared with those in DES "era" (group Ⅱ, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group).
Results Altogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft (CABG) successfully. Bifurcation techniques for distal LMCA executed in 206 patients (69.4%, 2061297), included crossover stenting in 156 (75.7%), T stenting in 4 (1.9%), provisional T stenting in 28 (13.6%), kissing stenting in 5 (2.4%) and stent crushing in 13 (6.3%) patients. During their hospital stay, 5 (1.7%) patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events (MACE) were 2.0% (6/297). In the follow-up period, 19 patients (6.5%) died [15 (5.1%) of cardiac death and 4 of non-fatal myocardial infarction (MI)]. Besides, 2 (0.7%) developed subacute thrombosis (SAT) and 16 (5.4%) performed target lesion revascularization (TLR). The total follow-up MACE was 14.5% (431297). Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement (14.7% vs 81.9%, P〈0.001), and more bifurcation lesions (32.4% vs 72.2%, P〈0.001). After PCI, in-hospital MACE of group II was significantly lower than that in group I (1.1% vs 9.4%, P〈0.05). And the incidences of MACE, TLR and angiographic restenosis in group II were all significantly lower than those in group I (all P〈0.05) after one year follow-up.
Conclusions As new PCI strategies and intervention devices such as DES are developed, coronary stenting, which might have brought better in-hospital and long-term outcomes than CABG are proved to be technically successful and can be safely applied for the treatment of LMCA lesions in the experienced center for coronary intervention. 相似文献
19.
目的 评价药物洗脱支架治疗冠状动脉无保护左主干(ULMCA)病变的安全性及疗效.方法 选择2002年10月~2007年11月我院收治经冠状动脉造影证实为无保护左主干病变患者44例;合并心功能不全(左室射血分数<40%)5例,肺功能减退2例,慢性肾功能不全5例;常规行冠状动脉造影及经皮冠状动脉介入治疗.分析其冠脉造影特征、手术成功率及临床随访结果 .结果 44例患者经皮冠状动脉介入治疗即刻成功率为100%,无严重术中并发症,手术住院期间的病死率、非致死性心肌梗死率及急诊常规行冠状动脉造影率均为0%.所有患者均植入药物洗脱支架.术后平均随访14.2~9.3月(6~65月),所有患者均未发生亚急性或延迟性支架内血栓形成;6例(13.6%)患者有心绞痛症状复发;1例患者在术后4个月困心力衰竭死亡;37例(84.1%)患者无严重不良心血管事件发生.35例(79.5%)患者进行了冠状动脉造影复查,其中冠状动脉造影复查提示发生再狭窄3例(8.6%):1例为左主干远端分叉病变,分叉处再狭窄转外科行常规行冠状动脉造影术;2例左主干末端分叉病变分支开口发生再狭窄,使用切割球囊再次经皮冠状动脉介入治疗后,症状缓解.结论 对选择性的冠状动脉左主干病变使用药物洗脱支架行介入治疗安全有效,近、远期疗效良好. 相似文献