无保护左主干病变不同治疗策略远期临床效果

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。

Long-term clinical outcomes of different treatment strategies for unprotected left main coronary artery lesion

Objective To evaluate the long-term clinical outcomes of different treatment strategies for treating unprotected left main(ULM)coronary artery lesion.Methods The incidence of the mayor adverse cardiac and cerebral events(MACCE)in 211 patients which received percutaneous coronary intervention with drug-eluting stent(DES)(DES group)and 176 patients which were given coronary artery bypass grafting(CABG) were compared.Results Compared with CABG group,the rate of repeat revascularization(RR)was higher and the rate of cardiac death was lower in the DES group(P<0.05).The correlation between the revascularization way and the rates of MACCE,total death,cardiac death,myocardial infarction,stroke was not found by propensity score(P>0.05).However,the DES had positive correlation with the long-term rates of repeat revascularization[hazard rate= 3.050,95% confidence interval(1.289,7.217),P<0.05].Conclusion Comparing with the DES,patients with ULM disease who are treated with CABG have more severe clinic status and coronary lesions.DES is the independent prediction factor of long-term RR incidence in patients with ULM lesion who are received revascularization.