经皮冠状动脉介入治疗对冠状动脉无保护左主干患者生活质量的影响

目的 对经皮冠状动脉介入（PCI）治疗无保护左主干（ULMCA）冠心病患者治疗前后的生活质量进行评价。 方法 收集2017年9月～2019年12月于西京医院心内科成功行PCI术的UMLCA患者（n=74）入院时的临床基本特征，随访术后不良事件（全因死亡、非致死性心肌梗死、临床驱动的再次血运重建），通过测评SF-12量表和西雅图心绞痛量表，比较PCI术前术后生活质量的改变。 结果 男性患者61例（82%），并发高血压病41例（55%），糖尿病22例（30%），吸烟史25例（34%），体质量指数24(23, 27) kg/m2。造影结果中冠状动脉左主干的狭窄程度(68±16)%、Gensini评分(140±43)分。左主干开口部位病变44例（60%），并发三支冠脉血管病变70例（95%），植入支架总长度为88（47,113）mm，手术持续时间为178 (108.270) min，造影剂使用量为300（195,400）ml。PCI术后电话随访（平均5.06月），全因死亡3例（4%）；临床驱动的再次血运重建4例（6%）。经过单因素分析提示患者年龄每增加1岁，术后主要不良心血管事件（MACE）的发生率增加1.15倍。两个量表均显示ULMCA病变患者的术后评分在各个维度上都比术前高（P<0. 05，P < 0. 01）。 结论 PCI治疗可改善ULMCA病变冠心病患者的生活质量。

Impact of percutaneous coronary intervention treatment on quality of life in patients with unprotected left main coronary disease

AIM To observe the changes of quality of life after percutaneous coronary intervention (PCI) in patients with unprotected left main (ULMCA) coronary heart disease. METHODS Clinical data, including age, gender, past history, personal history, operation history, vital signs, body mass index, blood lipids, blood sugar, renal function and left ventricular ejection fraction, were collected in 74 patients with ULMCA lesions who underwent successful PCI in the Department of Cardiology of Xijing Hospital from September 2017 to December 2019, and postoperative adverse events, including all-cause death, non-fatal myocardial infarction and clinically driven revascularization, were followed up. The changes of quality of life before and after PCI were compared by measuring SF-12 scale and Seattle angina pectoris scale. RESULTS Among the 74 cases with unprotected left main coronary heart disease, there were a large proportion of males (82%), 41 cases with hypertension (55%), 22 cases with diabetes (30%), 25 cases with smoking history (34%) and the median body mass index (BMI) was 24 (23, 27) kg/m2. The degree of stenosis of the left main artery was (68 ±16)% and the Gensini score was (140 ± 43). The left main lesion was mainly at the opening (60%), with a large proportion of three-vessel coronary artery disease (95%), a median total stent length of 88 (47, 113) mm, a median operation duration of 178 (108, 270) minutes and a median contrast agent dose of 300 (195, 400) ml. During the follow-up after PCI (mean 5.06 months), all-cause death occurred in 3 cases (4%) and revascularization of target vessels in 4 cases (6%). Univariate analysis showed that when the age of the patient increased by one year, the incidence of postoperative MACE increased by 1.15 times. The scores of SF-12 scale and SAQ in patients with ULMCA disease after PCI were significantly higher than those before operation (P<0.05, P <0. 01). CONCLUSION PCI treatment improves the quality of life of patients with coronary heart disease with ULMCA disease.