选择性支架置入术治疗无保护左主干病变的临床疗效分析

目的：比较选择性支架置入术、外科旁路手术以及药物保守治疗对无保护左冠状动脉主干病变患者症状改善和近期远期预后的影响。方法：选取73例无保护左主干病变患者，按治疗干预方法分为选择性支架置入组（17例）、外科旁路手术（CMY3）组（38例）和药物保守治疗组（18例），随访3～41个月，分析比较其临床造影特征、手术效果和近期中期预后。结果：3组患者在危险因素、症状、体征以及主要辅助检查均无显著差异（P〉0.05）。临床预后分析显示，选择性支架置入组和CABG组的手术成功率均为100％；3组患者的住院期间生存率：选择性支架置入组为100%，CABG组为94．7%（36／38），药物治疗组为100％，3者之间无显著差异（P〉0.05）；3年生存率：选择性支架置入组为100％，CABG组为92．1％（35／38），两者之间无显著差异（P〉0．05），药物治疗组为77．8％（14／18），与另外两组相比有显著差异（P〈0.05）；远期主要心脏不良事件发生率：选择性支架置入组为17．6％（3／17），CABG组为21．1％（8／38），两者之间无显著差异（P〉0．05），药物治疗组为44．4％（8／18），与另外两组相比有显著差异（P〈0．05）；3年无事件生存率：选择性支架置入组为69．3％，CABG组为63．6％，两者之间无显著差异（P〉0.05），药物治疗组为20．9％．与另外两组相比有显著差异（P〈0．05）。3年生存率和无事件生存率的Kaplan Meier曲线显示，选择性支架置入术与外科旁路手术相比，在改善患者预后方面无显著差异（P〉0.05），但两者均明显优于单纯药物治疗（P〈0.05）。结论：选择性支架置入术是治疗左冠状动脉主干狭窄性病变的有效治疗手段。可以显著改善患者的近期和远期预后，降低远期死亡率和主要心血管事件发生率。其治疗效果明显优于单纯药物保守治疗，与CABG相比则无明显差异。

Unprotected Left Main Coronary Artery Stenting: Immediate and Late Clinical Outcomes

Objective:We sought to investigate the safety and efficacy of elective coronary artery stenting in selected patients with unprotected left main (LMCA) disease by evaluating the immediate and late clinical outcomes after elective stenting and comparing the effect on prognosis with coronary artery bypass graft (CABG) and conservative medical therapy. Methods Clinical data of 73 selected patients with unprotected left main coronary artery stenosis had been retrospectively aralysed. The study patients were divided into coronary stenting group, CABG group, and conservative medical therapy group. All of the three groups were followed-up for 3 to 41 months. The information documented includes clinical characteristics, cardiac death (in-hospital and 3-years), and the major adverse cardiac event (MACE). Results: A total of 73 patients with unprotected left main disease were enrolled. Seventeen patients were performed elective stenting, 38 patients received CABG surgery and 18 patients were only treated with medication. There were no significant differences among the three groups in the risk factors, clinical symptoms, physical examinations, and the main laboratory examinations. The procedure success rate was 100% in the stenting group and the CABG group (P>0.05). The in-hospital survival rate was 100% in the stenting group, 94.7% (36/38) in the CABG group, and 100% in the medical therapy group (P>0.05). Three-years survival rate was 100% in the stenting group and 92.1 % (35/38) in the CABG group (P>0.05). Three-years survival rate in the conservative group was 77.8% (14/18), and was significantly lower than the stenting group and the CABG group (P<0.05). The incidence of the MACE during the follow-up period was 17.6% (3/17) in the stenting group and 21.1 % (8/38) in the CABG group (P>0.05), and was significantly lower than the medical therapy group (44.4%, 8/18), (P<0.05). Three-years event free survival rate was 69.9% in the stenting group and 63.6% in the CABG group (P>0. 05), and was significantly higher than the medical therapy group (20.9%, P<0.05). The Kaplan Meier survival curves of the three groups also showed the similar effect on prognosis of elective stenting and CABG. The curves of the elective stenting group and the CABG group were better than medical therapy group (P<0.05). Conclusion:The elective stenting can be considered as one of the first therapies in selected LMCA stenosis, especially in isolated LMCA stenosis, which provided an excellent immediate and late result similar with the CABG and could improve the clinical prognosis effectively. In institutions performing large numbers of PCIs, it can be considered a safe and effective alternative to CABG.