孤立性左冠状动脉主干狭窄的诊治分析

目的分析孤立性左冠状动脉主干(左主干)狭窄的临床特点、造影所见和治疗方法.方法根据冠状动脉造影病变特点将129例左主干狭窄患者分为两组:孤立性左主干狭窄组7例;左主干合并一支或以上主要冠状动脉支狭窄组122例,对比分析两组间临床特点、造影所见和治疗方法.结果孤立性左冠状动脉主干狭窄的检出率为0.16%.6例表现为不稳定型心绞痛,1例为急性前壁心肌梗死.左主干狭窄部位:开口部4例,中部2例,叉口部1例.4例行外科手术,3例行冠状动脉支架术.与复合病变组相比较,孤立性左主干狭窄组女性的比例较高(57.1%vs20.5%,P<0.05),平均年龄较小[(52.3±5.1)岁vs(64.2±7.8)岁,P<0.001];开口部狭窄多见(57.1%vs17.2%,P<0.05).结论孤立性左冠状动脉主干狭窄以女性多见,以开口部狭窄多见,可选择外科和介入治疗.

Clinical analysis of isolated left main coronary artery stenosis

Objective To analyze the clinical features,findings of coronary angiography and treatment in patients with isolated left main coronary artery(LM) stenosis.MethodsOne hundred and twenty nine patients with LM stenosis were divided into two groups according to the findings of coronary angiography: patiets had only LM stenosis(1 LMS group),and combined LM stenosis(CLMS group).Patients had LM stenosis and at least one major coronary artery stenosis.Seven in isolated LM stenosis group,and 122 in CLMS group.The clinical features,findings of coronary angiography and treatment were compared between two groups.ResultsThe incidence rate of isolated LM stenosis was 0.16%.Six patiets had unstable angina and 1 had acute anterior wall myocardial infarction.CAG showed 4 patients had LM stenosis at the ostium,2 at midportion and 1 at bifurction portion.Three patients underwent coronary artery bypass grafting(CABG),one underwent left main coronary artery patch angioplasty,and 3 patients underwent percutaneous coronary intervention(PCI).Compared with the CLMS group,the proportion of female was higher in 1LMS group(57.1 % vs 20.5 %,P<0.05),the average age was younger(52.3 ± 5.1 vs 64.2 ± 7.8,P<0.001) and the incidence of ostium stenosis was higher in(57.1 % vs 17.2 %,P<0.05).ConclusionsIsolated LM stenosis is relatively common in female and is usually located at the ostium.CABG and PCI can be chosen for the treatment according to clinical condition of the patient.