论文部分内容阅读
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。
Objective To investigate the safety of coronary stenting in the treatment of patients with unprotected left main coronary artery (ULMCA) and the average postoperative 2 years. Methods The data of 416 cases of ULMCA undergoing coronary stent implantation from September 1997 to January 2007 in Shenyang General Hospital of PLA General Hospital were retrospectively analyzed. Results In the treatment group, 291 cases (70.0%) had distal bifurcation lesions. A total of 503 scaffolds were implanted in ULMCA target lesions, with 1.2 ± 0.7 scaffolds per patient. The success rate of stent implantation was 99.5%. There were no deaths during hospitalization and 2 cases of target lesion reconstruction. The incidence of major adverse cardiac events (MACE) was 0.5% (2/416). During the follow-up period, 16 patients died (3.9%), including 12 cardiac deaths (2.9%). Follow-up was performed in 136 cases (33.1%), 20 cases of restenosis (restenosis rate was 14.7%, 20/136), of which 14 cases underwent coronary artery bypass grafting and 6 cases were implanted with drug-eluting stents. The overall MACE rate was 8.3% (34/411) after PCI in patients with ULMCA. Conclusion The success rate of coronary stenting in the treatment of unprotected ULMCA with high perioperative safety is better than that of 2-year follow-up. Effective strategies to reduce the incidence of post-PCI restenosis and MACE (such as drug-eluting stent selection and implantation methods) deserve further discussion.