不同血运重建策略对冠状动脉左主干病变合并左心室收缩功能不全患者预后的影响  

Analysis of different revascularization strategies on the prognosis of patients with left main coronary artery disease and left ventricular systolic dysfunction

作　　者：潘昱[1] 穆煜 张宇晨[1] 何继强[1] 仇琪[2] PAN Yu;MU Yu;ZHANG Yuchen;HE Jiqiang;QIU Qi(Department qf Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute qf Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所临床药理中心,100029

出　　处：《心肺血管病杂志》2020年第12期1435-1439,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：“重大新药创制”科技重大专项(2017ZX09304017);北京市科委课题(Z161100000116076)。

摘　　要：目的:探讨药物洗脱支架(DES)置入术和冠状动脉旁路移植术(CABG)治疗无保护左主干病变(ULM)患者伴左心室收缩功能不全(LVSD)的临床疗效。方法:回顾性分析冠状动脉左主干病变合并LVSD患者的临床参数和预后。共纳入326例合并LVSD的ULMCA患者,并按LVEF分层。139例40%(重度LVSD)(DES,n=104;CABG,n=35),187例40%<LVEF≤49%(轻度LVSD)(DES,n=137;CABG,n=50)。结果:重度LVSD、轻度LVSD两层ULM病变患者临床特点比较,多支血管病变(MVD)发病率、完全血运重建比例CABG组显著高于DES组。重度LVSD分层CABG组慢性完全闭塞更多见(CTO)及脑卒中发病率高,而DES组的陈旧心肌梗死(OMI)发生率明显高于CABG组。两种LVSD分层CABG组与DES组主要心脑不良事件(MACCE)、全因死亡、心源性死亡、心肌梗死(MI)或卒中,差异无统计学意义。结论:对于伴有LVSD的ULM病变患者,DES与CABG的疗效和安全性无显著差异。DES是较为安全有效的、可接受性较好的血运重建策略,可作为此类患者血运重建的一种选择方案。Objective:To study the clinical effect of drug-eluting stent(DES)implantation and coro-nary artery bypass grafting(CABG)in the treatment of unprotected left main artery disease(ULM)patients with or without left ventricular systolic dysfunction(LVSD).Background:The optimal strategy of coronary artery reconstruction in patients with ULM and LVSD has not been determined.Methods:The clinical parame-ters and prognosis of patients with left main coronary artery disease and LVSD were analyzed retrospectively.A total of 326 ULMCA patients with LVSD were enrolled and stratified according to LVEF.There were 139 patients with LVEF≤40%(severe LVSD)(DES,n=104;CABG,n=35),187 patients with 40%<LVEF≤49%(mild LVSD)(DES,n=137;CABG,n=50).Results:The clinical characteristics of patients with severe LVSD and mild LVSD two slice ULM lesions were significantly higher than those of DES group in inci-dence rate of multivessel disease(MVD)and complete revascularization(CABG).Severe LVSD stratified CABG group had more chronic total occlusion(CTO)and higher incidence of stroke,while the incidence rate of Old myocardial infarction(OMI)in DES group was significantly higher than that in group A.There was no significant difference in major cardio cerebral adverse events(MACCE),all-cause death,cardiogenic death,myocardial infarction(MI)or stroke between CABG group and des group.Conclusions:There is no significant difference in efficacy and safety between DES and CABG in the treatment of ULM with LVSD.DES can be used as an alternative treatment for these patients.

关 键 词：无保护左主干病变 左心室收缩功能不全 药物洗脱支架 冠状动脉旁路移植术 

分 类 号：R54[医药卫生—心血管疾病]