无保护左主干病变冠状动脉搭桥术与雷帕霉素洗脱支架治疗的对比研究  

Comparison between drug-eluting stents and coronary artery bypass surgery for the treatment of unprotected left main coronary artery stenosis

作　　者：庞明杰[1] 张宏[1] 赵燕[1] 陶杰[2] 张云梅[1] 吴咏昕[1] 

机构地区：[1]云南省第一人民医院心内科,昆明650032 [2]昆明医学院第一附属医院心外科

出　　处：《临床心血管病杂志》2012年第7期511-514,共4页Journal of Clinical Cardiology

摘　　要：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。To evaluate the effect of coronary artery bypass grafting （CABG） and percutaneous coro- nary intervention （PCI） with drug-eluting stents （DES） for unprotected left main coronary artery disease and investigate the relevance between the risk of lesion and major adverse cardiac and eerebrovascular event （MACCE） by syntax score system. Method： We reviewed outcomes among 176 consecutive patients with unprotected left main coronary artery disease who underwent PCI or CAGB. Eighty patients underwent CABG （CABG group） and nin ty-six patients received drug-eluting stents （PCI group）. Base features, angiographic characteristics, operation data, SYNTAX SCORE and MACCE rates followed up 3 years after operation were recorded. Result：There were more target vessel revaseularization events in the PCI group than in the CABG group, although MACCE and MACCE-free rates were similar at 3 years follow-up. Patients were divided into high-score group （≥30.0） and low-score group （〈30.0） by using SYNTAX SCORE system. SYNTAX SCORE〉30.0 is the independent risk factor of the outcomes of PCh In the high-score group, MACCE was higher and MACCE-free rate was lower at 3 years in patients underwent PCI than CABG （23.53% vs 18.05%, P〈0.05; 51.47% vs 70.83%, P〈0.05, respectively）. In the low-score group, MACCE was higher in patients underwent CABG than PCI at 3 years （12.505 vs 7.14%, P〉0.05）, but MACCE-free rate was lower in patients underwent CABG than PCI at 3 years follow-up （75.00% vs 82. 14%, P〈0.05）. Conclusion： PCI with DES is feasible and effective for patients with unprotected left main coronary artery disease.

关 键 词：药物洗脱支架 无保护左主干病变 SYNTAX SCORE 冠状动脉旁路移植术 预后 

分 类 号：R541.4[医药卫生—心血管疾病]