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目的 探讨无保护左主干病变 (UPLMT)经皮冠状动脉介入治疗 (PCI)的近、远期疗效。方法 自 1992年 12月至 2 0 0 2年 12月期间 ,对 174例UPLMT行PCI,其中定向斑块旋切术 (DCA) 12 1例 ,支架术 5 3例。其中 85例被列为不能耐受冠状动脉旁路移植术 (CABG)或外科手术高危。术后半年内每月至少门诊复查一次 ,以后定期随诊、电话随访。术后 3、6、12月行冠状动脉造影复查。结果 PCI术均获血管造影成功。住院期间主要不良心脏事件 (MACE) 16例 (9 2 % ) ,15 8例 (90 8% )获操作成功。术后半年随访发现死亡 17例 (9 8% ) ;其中心源性死亡 8例 (4 6 % ) ,均发生于不能耐受CABG或外科手术高危组。半年内有 15 2例患者接受冠状动脉造影复查 ,其中有 36例 (2 3 7% )行血管重建。Kaplan Meier生存分析显示 :PCI术后 1年、3年生存率 (免于死亡 )分别为 89 7%、84 5 % ,术后 1年、3年免于心脏事件的生存率分别为 6 3 8%、5 7 5 %。结论 对UPLMT ,尤其是开口部、体部病变 ,PCI的近期疗效可以接受 ,但术后主要心脏事件 (如血管重建、心肌梗死、死亡等 )有待进一步减少。
Objective To investigate the short-term and long-term effects of unprotected left main coronary artery disease (UPLMT) on percutaneous coronary intervention (PCI). Methods From December 1992 to December 2002, 174 UPLMT patients underwent PCI, including 12 cases of directional atherectomy (DCA) and 53 cases of stenting. Of these, 85 were classified as not tolerant to coronary artery bypass grafting (CABG) or surgery at high risk. Within six months after surgery at least clinically reviewed once a month, after regular follow-up, telephone follow-up. Postoperative 3, 6, December coronary angiography review. Results PCI was successful angiography. 16 cases (92%) of major adverse cardiac events (MACE) during hospitalization and 15 8 cases (908%) were successfully operated. Seventeen patients (9.8%) were found dead at six months follow-up. Eight patients (46%) died of cardiac-related death, all of which occurred in those who could not tolerate CABG or surgical high risk group. Fifty-two patients underwent coronary angiography within six months, of which 36 (23.7%) underwent revascularization. Kaplan Meier survival analysis showed that the 3-year survival rates (death-free survival rates) at 1 year after PCI were 89.7% and 84.5%, respectively. The 1-year and 3-year survival rates after cardiopulmonary bypass were 6 3 8 %, 57 5%. Conclusions The short-term curative effect of UPLMT, especially on the opening, body lesion and PCI, is acceptable. However, postoperative major cardiac events such as revascularization, myocardial infarction and death need to be further reduced.