There are limited data on longer-term outcomes (>5 years) for patients with unprotected left main coronary artery (ULMCA) disease who underwent percutaneous coronary intervention (PCI) in the drug-eluting stents (DES) era. This study aimed at comparing the long-term (>5 years) outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting (CABG) and the predictors of adverse events.
Methods:
All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups.
Results:
Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses (DES = 465 vs. CABG = 457). During the median follow-up of 7.1 years (interquartile range 5.3–8.2 years), no difference was found between PCI and CABG in the occurrence of death (P = 0.282) and the composite endpoint of cardiac death, myocardial infarction (MI) and stroke (P = 0.294). Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group (P = 0.014) in large part because of the significantly higher rate of repeat revascularization (P < 0.001). PCI was correlated with the lower occurrence of stroke (P = 0.004). Multivariate analysis showed ejection fraction (EF) (P = 0.012), creatinine (P = 0.016), and prior stroke (P = 0.031) were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age (P = 0.026) and EF (P = 0.002) were independent predictors in the CABG group.
Conclusions:
During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age and EF were independent predictors in the CABG group. 相似文献
A 71-years-old man presented with an incidentally finding of a tumor in the left pulmonary apex that measured approximately 4.5 cm of diameter. The patient, had de preceding of chronic smoking. Bronchoscopy with biopsy by transthoracic punction suggested the presence of epidermoid carcinoma. In the radiologic control, an increase in tumor size from 4.5 cm to 5 cm of the lesion was observed in a period of three months. The patient was submited to surgery and a tumorectomy by posterolateral thoracotomy was performed. The postoperatory evolution was satisfactory. The final diagnosis was hamartoma of the lung. 相似文献
The effects of D1/5 dopamine agonists on spontaneous excitatory postsynaptic currents (sEPSCs) were studied in neurons of the rat globus pallidus using whole-cell recordings in the presence of TTX and bicuculline. In this condition, CNQX abolished the sEPSCs, indicating that they were solely mediated by AMPA receptors. SKF 38393, a D1-like agonist, increased the frequency but not the amplitude of the sEPSCs, suggesting a presynaptic site of action. The increase in frequency was blocked by SCH 23390, a D1/5 antagonist. Quinpirole, a D2-like agonist, decreased the frequency but did not affect the amplitude of the synaptic currents. SKF 38393 increased the frequency of sEPSCs currents, even in presence of quinpirole, indicating that D1/5- and D2-like receptors independently modulate glutamate release upon a single neuron. The results suggest that the dopaminergic control of the glutamate transmission in the globus pallidus may play a role in processing cortical information in the indirect pathway of the basal ganglia. 相似文献
In newborns, hypoxia elicits defensive behaviors including awakening from sleep, body movements and crying. An inability to produce this defense response is a risk factor for sudden infant death syndrome and other respiratory control disorders. In this study, we examined the possibility that the defense response to hypoxia in newborns is partly determined by early exposure to hypoxia. We explored this possibility in 6-day-old mice, which resemble human preterm infants of approximately 25–30 weeks’ gestational age. Ultrasonic vocalizations (USVs) were recorded as a marker for the defense response to hypoxia. In a conditioning experiment, newborn mice were exposed to two artificial odors (conditioned stimuli, CS). For acquisition (two trials), pups were exposed to one odor (CS+) in a hypoxic gas mixture (10% O2, which was the unconditioned stimulus, US) and to another odor (CS−) in air. Then, the pups were exposed to each odor while breathing air. Newborn mice produced significantly more USVs when exposed to the odor previously paired with hypoxia than to the control odor. Thus, associative learning may shape the defense response to hypoxia in newborns. 相似文献