药物洗脱支架治疗冠状动脉无保护左主干病变远期临床效果分析  

Long-Term Outcomes after Implacement of Drug-Eluting Stent in Unprotected Left Main Coronary Artery Disease Patients

作　　者：张晓玲[1] 陈方[1] 玉献鹏[1] 罗亚玮[1] 张维东[1] 高阅春[1] 

机构地区：[1]首都医科大学附属北京安贞医院,北京心肺血管疾病研究所,北京市100029

出　　处：《中国全科医学》2011年第24期2734-2737,共4页Chinese General Practice

基　　金：首都医学发展科研基金(2009-2074)

摘　　要：目的探讨药物洗脱支架(drug-eluting stent,DES)治疗冠状动脉无保护左主干(unprotected left main artery,ULM)病变远期临床效果。方法回顾性分析211例冠心病ULM病变患者临床特点,并观察置入DES后远期主要心脑血管事件(major adverse cardiac and cerebral events,MACCE)发生情况。结果 211例ULM病变患者中不稳定型心绞痛145例(68.7%),ULM病变在远段分叉部占75.4%,151例(71.6%)ULM患者存在多支病变。单支架治疗分叉病变119例(74.8%)。平均随访(28.9±11.8)个月。38例(18.0%)发生MACCE,23例(10.9%)靶血管再次血运重建,10例(4.7%)心肌梗死,3例(1.4%)脑卒中,9例(4.3%)死亡。远段与非远段ULM病变DES治疗后远期MACCE发生率比较,差异无统计学意义(Log-rankP=0.62)。单支架与双支架治疗左主干远段病变DES治疗后远期MACCE发生率比较,差异无统计学意义(Log-rankP=0.795)。合并2型糖尿病ULM病变DES治疗后远期MACCE发生率明显高于单纯ULM患者,差异有统计学意义(Log-rankP=0.026)。结论对冠状动脉ULM病变选择性使用DES行介入治疗安全有效,远期疗效良好。2型糖尿病是ULM病变支架术后远期MACCE的独立预测因子。Objective To evaluate the long - term clinical outcomes after implacement of drug - eluting stent in pa- tients with unprotected left main coronary artery （ULMCA） disease. Methods PCI with DES was performed in 211 consecutive patients with ULMCA disease between september 2006 and march 2Q10, with the long - term clinical outcomes studied. Results Of the 211 ULM patients, 145 （68.7%） were with unstable angina and 75.4% of the cases were with distal ULM, multivessel coronary disease were noticed in 151 （71.6%） cases. Single stent was applied in 119 （74. 8% ） for distal ULM patients. All pa- tients were followed up for an average of （28. 9 ~ 11.8） months. Major adverse cardiac or cerebrovascular events （MACCE） were seen in 38 （ 18.0% ） patients. There were 9 （ 4. 3% ） cases of deaths, 10 （ 4. 7% ） of myocardial infarction （ MI ）, 23 （ 10. 9% ） of target vessel revascularization, and 3 （ 1.4% ） of cerebrovaseular events. MACCE occurrence rates were similar be- tween distal and no - distal ULM patients （ Log - rank P = 0. 62 ） . No significant statistical differences existed in btAGGE occur- rence rate between single - stent and two - stent technology in treating distal ULM （ Log - rank P = 0. 795 ） . Compared with non - diabetic ULM patients, the rate of MACCE was significantly higher in ULM patients with complicated type - 2 diabetes （ LOg - rank P = 0. 026） . Conclusion The present study demonstrates that PCI with drug - eluting stent implaeement is a safe and ef- fective method in treatment of unprotected left main coronary artery disease. Diabetes mellitus is among the independent predictors of MACCE followin~ coronary stenting in ULM oatients.

关 键 词：冠心病 血管成形术 药物洗脱支架 

分 类 号：R543.31[医药卫生—心血管疾病]