介入治疗在无保护左主干病变中的应用——对不能耐受旁路移植术或手术高危患者的疗效

目的　探讨经皮冠状动脉介入治疗 (PCI)在不能耐受冠状动脉旁路移植术 (CABG)或手术高危的无保护左主干病变 (UPL MT)患者中的应用及近、远期疗效。方法　自 1993年 2月至 2 0 0 2年 8月期间 ,对 85例被列为不能耐受 CABG或手术高危的 UPL MT进行了 PCI治疗 ,其中定向斑块旋切术 (DCA) 4 8例 ,支架术 37例。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术均获技术成功(术后残余直径狭窄 <5 0 % ,且获得 TIMI3级血流 )。住院期间主要不良心脏事件 (MACE)共 12例 (14 .1% ) :死亡9例 (10 .6 % ) ,其中心源性死亡 3例 (3.5 % ) ;再次 PCI术 3例 (3.5 % ) ;无 Q波心肌梗死、急诊 CABG。术后半年随访发现死亡共 15例 (17.6 % ) ,其中心源性死亡 8例 (9.4 % ) ;半年内共有 71例患者接受冠状动脉造影复查 ,其中对19例 (2 6 .8% )进行了靶血管重建 ;对资料完整的 6 4例患者作左心室射血分数 (L VEF)对比分析 ,结果显示 :PCI术后 (3或 /和 6个月 ) L VEF较术前显著改善 (5 .5± 8.7% ,P<0 .0 5 )。Kaplan- Meier生存分析显示 :PCI术后 1年、3年 (免于死亡 )的生存率为 81.2 %、76 .5 % ,免于心源性死亡的生存率为 90 .6 %、89.4 % ,免于心脏事件的生

Percutaneous coronary intervention for unprotected left main coronary artery stenoses in patients ineligible for bypass grafting or at high surgical risk

Objective This study attempted to evaluate the initial and long-term outcomes of unprotected left main trunk (UPLMT) patients ineligible for coronary artery bypass grafting (CABG) or at high surgical risk. Methods Between February 1993 and August 2002, percutaneous coronary intervention (PCI) was performed for UPLMT in 85 patients clarified as CABG ineligible or at high surgical risk, including 48 directional coronary atherectomy (DCA) and 37 stenting procedures. 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 at 3, 6 and 12 months after initial PCI. Results Technical success was achieved in all patients. Nine patients died (3 with cardiac origin), and 3 received repeat angioplasty during hospitalization. There was no Q-wave myocardial infarction and emergency CABG. At 6-month follow-up, all-cause mortality was 17.6% (15/85), cardiac mortality was 9.4% (8/85); 71 patients received follow-up angiography and target lesion revascularization (TLR) was performed in 19 (26.8%) patients; measurements of LVEF at baseline and 3- or/and 6-month were possible in 64 patients, significant improvement in LVEF was observed (5.5± 8.7 %, P<0.05). The estimated cardiac death-free, death-free, cardiac event-free survival was 90.6%, 81.2%, 51.7% at 1-year, 89.4%, 78.8%, 48.2% at 2-year, and 89.4%, 76.5%, 44.7% at 3-year. Conclusion PCI is feasible, with acceptable immediate results in UPLMT patients ineligible for CABG or at high surgical risk. However, long-term cardiac events, including restenosis, TLR and death remain relatively high.