药物洗脱支架精确定位与贯穿左冠状动脉主干治疗冠状动脉前降支口部病变的对照研究

目的 比较药物洗脱支架(DES)治疗前降支(LAD)开口病变精确定位法和贯穿左冠状动脉主干(LM)法的优劣.方法 回顾性分析2004年4月至2006年5月北京阜外心血管病医院对LAD开口病变用DES行经皮冠状动脉介入治疗(PCI)的224例患者,其中精确定位有161例(P组),贯穿入LM有63例(C组).结果 基线上C组的参考血管直径(RVD)明显大于P组,而LM和LAD管腔的落差P组明显大于C组.在介入操作特点上,支架直径、球囊后扩张的比率、后扩张球囊直径和左主干分叉处行双球囊对吻技术(kissing balloon)的比率C组均明显大于P组.两组介入成功率均为100%.两组主要不良心脏事件(MACE)发生率差异无统计学意义(4.3%比1.6%;P=0.447),其中死亡、急性心肌梗死、靶血管重建两组差异也无统计学意义(0比0,P=1.000;1.2%比1.6%,P=1.000和3.1%比0,P=0.325).只有1例亚急性血栓发生在P组.造影随访C组支架内和血管段再狭窄率有降低的趋势(7.7%比0,P=0.316;10.8%比3.8%,P=0.431).支架内和血管段的晚期丢失C组均明显小于P组[(0.12±0.08)mm比(0.59±0.37)mm,P=0.000和(0.17±0.09)mm比(0.64±0.49)mm,P=0.000].结论 DES治疗LAD口部病变贯穿LM法和精确定位法均可显示较好的有效性和安全性.与精确定位法相比,贯穿LM法有更强的可操作性和降低再狭窄的趋势.

Effects of treating ostial left anterior descending artery stenosis by drug eluting stents via precisely positioning or crossing over into left main stem

Objective To compare the effect of treating ostial left anterior descending artery (LAD)stenosis using drug-eluting stents(DES)by precisely positioning versus crossing over into left main (LM)technique.Methods From April 2004 to May 2006,DES implantations in 224 consecutive patients with ostial LAD lesions were performed by precisely positioning in 161 patients(P group)and crossing over into LM in 63 patients(C group).Clinical and angiographic follow-up was performed at 7 months post DES implantations.Results Relevant vessel diameter(RVD)was significantly larger(3.44±0.52 mm vs. 3.17±0.40 mm,P=0.039)and LM/LAD diameter ratio was significantly lower(1.16±0.07 vs.1.28± 0.05,P=0.000)in C group compared that in P group.Stent(3.53±0.31 mm vs.3.16±0.29 mm,P=0.035)and postdititation balloon(3.59±0.65 mm vs.3.24±0.32 mm,P=0.035)diameter were significantly larger and postdilitation(94.1%vs.29.5%,P=0.000)and kissing balloon(47.1%vs.15.2%,P=0.000)rates were significantly higher in P group than that in C group.Both groups achieved 100%Droeedure success rate.Major adverse cardiac events(MACE)rate(4.3%vs.1.6%,P=0.447),death(0 vs.0,P=1.000),AMI(1,2%vs.1.6%,P=1.000)and target vessel revascularization (TVR)rate(3.1%vs.0%,P=0.325)were similar between the 2 groups.One patient in P group developed subacute in-stent thrombosis.Follow-up angiography at 7 months showed that in-stent(0 vs.7.7%,P=0.316)and in-segment restenosis rate(3.8%vs.10.8%,P=0.431)tended to be lower while in-stent(0.12±0.08 mm vs.0.59±0.37 mm,P=0.000)and in-segment(0.17±0.09 mm vs.0.64±0.49 mm,P=0.000)late loss were significantly lower in C group compared with P group.Conclusion Compared with precisely positioning technique,crossing over into LM technique was more feasible and tended to reduce restenosis rate for ostial LAD lesions treated with DES.