冠状动脉支架术治疗416例择期无保护左冠状动脉主干病变的2年随访

目的探讨冠状动脉支架术治疗择期无保护左冠状动脉主干（ULMCA）病变的安全性和术后平均2年的临床效果。方法回顾分析1997年9月至2007年1月在沈阳军区总医院接受冠状动脉支架植入术的416例ULMCA的病例资料。结果治疗对象中病变位于远端分叉处291例（70．0％）。ULMCA靶病变共植入支架503枚,人均植入支架（1．2±0．7）枚。支架植入成功率99．5％,住院期间无死亡病例,靶病变重建2例,主要不良心脏事件（MACE）发生率0．5％（2／416）。随访期内共死亡16例（3．9％）,其中心源性死亡12例（2．9％）。造影随访136例（33．1％）,靶病变发生再狭窄20例（再狭窄率14．7％,20／136）,其中14例行冠状动脉搭桥术,6例植入药物洗脱支架。ULMCA病变择期行PCI后总的MACE发生率为8．3％（34／411）。结论冠状动脉支架术治疗择期无保护ULMCA病变的技术成功率、围术期安全性均较高,平均随访2年疗效较好。降低PCI术后再狭窄和MACE发生率的有效策略（如药物洗脱支架的选择和植入方法等）值得进一步探讨。

Efficacy of stenting for selective unprotected left main coronary artery disease: two-year follow-up of 416 patients

OBJECTIVE: To evaluate the safety and effectiveness of stenting for selective unprotected left main coronary artery (ULMCA) disease. METHODS: The clinical data of 416 patients with ULMCA who underwent selective percutaneous coronary intervention (PCI) were analyzed. RESULTS: In 291 of the 416 patients (70.0%), the ULMCA lesions were located in the distal bifurcation site. A total of 503 stents were successfully deployed in 414 patients and the mean stent number was (1.2+/-0.7) stents per patient. The success rate of stenting procedure was 99.5%. During hospital stay, no patient died. The major adverse cardiac event (MACE) during in-hospitalization was 0.5% (2/416). The target lesion revascularization (TLR) rate was 4.9%. During the follow-up 16 (3.9%) patients died including 12 cases (2.9%) of cardiac death. Angiography during follow-up conducted on 136 (33.1%) patients showed that binary in-stent restenosis occurred in 20 patients (14.7%, 20/136). TLR was performed by coronary artery bypass graft in 14 patients and by drug eluting stent (DES) implantation in 6 patients respectively. The total MACE rate was 8.3% (34/411). CONCLUSION: Safe and with favorable clinical outcome, selective coronary stenting for ULMCA lesions can achieve a high technical success rate.