论文部分内容阅读
目的:回顾性分析无保护左主干病变患者使用雷帕霉素洗脱支架(DES)的经皮冠状动脉介入治疗(PCI)与冠状动脉旁路移植手术(CABG)治疗的中、远期疗效,并探讨应用SYNTAX SCORE来评估病变风险与临床事件的相关性。方法:本研究回顾性收集了176例无保护左主干病变患者,其中CABG组80例,PCI-DES组96例。收集患者的基本情况、左主干病变特点及SYNTAX评分、CABG和PCI手术情况,随访患者术后3年的主要不良心脑血管事件(MACCE)的发生率。结果:术后3年随访,PCI-DES组与CABG组的MACCE发生率及无MACCE生存率比较差异无统计学意义,但PCI组靶血管再次血运重建率(TVR)明显高于CABG组(P<0.05)。用SYNTAX SCORE把PCI-DES和CABG两组患者分为高积分组(≥30.0)和低积分组(<30.0):高积分组,术后3年PCI-DES亚组MACCE事件发生率高于CABG亚组(23.53%∶18.05%,P<0.05),无MACCE事件生存率低于CABG亚组(51.47%∶70.83%,P<0.05)。低积分组,术后3年MACCE事件发生率CABG亚组高于PCI-DES亚组(12.50%∶7.14%,P>0.05),而无MACCE事件生存率低于PCI-DES亚组(75.00%∶82.14%,P<0.05)。结论:PCI-DES与CABG治疗无保护左主干病变患者总体疗效相似。用SYNTAX SCORE指导无保护左主干病变血管重建方式的选择有重要价值,但在不同的患者人群中,仍应结合临床特征和冠状动脉病变特点选择恰当的血运重建术。
OBJECTIVE: To retrospectively analyze the long-term and long-term outcomes of percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) in patients with unprotected left main disease using rapamycin-eluting stent (DES) And to explore the use of SYNTAX SCORE to assess the relationship between the risk of disease and clinical events. METHODS: This study retrospectively collected 176 patients with unprotected left main disease, 80 in the CABG group and 96 in the PCI-DES group. The patient’s basic condition, left main lesion characteristics, SYNTAX score, CABG and PCI were collected. The incidence of major adverse cardiovascular and cerebrovascular events (MACCE) after 3 years of follow-up was followed up. Results: There was no significant difference in MACCE incidence and MACCE-free survival rate between PCI-DES group and CABG group at 3-year follow-up, but the target vessel revascularization rate (TVR) in PCI group was significantly higher than that in CABG group P <0.05). PCI-DES and CABG patients were divided into high-score group (≥30.0) and low-score group (<30.0): high-score group with SYNTAX SCORE. The incidence of MACCE events in PCI-DES subgroup after 3 years was higher than that of CABG Subgroup (23.53%, 18.05%, P <0.05). No MACCE event was lower than CABG subgroup (51.47%, 70.83%, P <0.05). Low-score group. The incidence of MACCE events at 3 years after operation was higher in CABG subgroup than in PCI-DES subgroup (12.50% vs 7.14%, P> 0.05) : 82.14%, P <0.05). Conclusion: The overall efficacy of PCI-DES and CABG in patients with unprotected left main disease is similar. The use of SYNTAX SCORE to guide the choice of vessel revascularization for unprotected left main disease is of great value. However, in different patient populations, proper revascularization should be selected in combination with clinical features and characteristics of coronary lesions.