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目的研究不同血管重建方式对无保护左主干(ULMCA)末端病变患者治疗的效果及预后意义。方法连续收录冠状动脉造影明确诊断为ULMCA末端病变的222例患者临床资料,其中106例置入药物洗脱支架(PCI组),116例行冠状动脉旁路移植手术(CABG组),观察两组患者在12个月及3年发生全因死亡、非致死性心肌梗死、靶血管重建和主要不良心脏事件发生率,研究不同血管重建方式对ULMCA末端病变治疗效果的影响。结果两组患者在12个月期间,主要终点事件如全因死亡、非致死性心肌梗死差别无统计学意义(分别为:χ2=1.05,P=0.32和χ2=1.04,P=0.38),靶血管重建以及主要不良心脏事件发生率差异有统计学意义(分别为:χ2=5.45,P=0.02和χ2=6.63,P=0.01)。累积3年随访,PCI组与CABG组相比全因死亡率降低33%(10.38%比12.07%,χ2=0.47,P=0.45),但非致死性心肌梗死是后者的1.87倍(2.1%比0,χ2=1.04,P=0.38)。PCI组靶血管重建率是CABG组4.17倍(20.76%比8.62%,χ2=6.63,P<0.01),而主要不良心脏事件两组相比差异有统计学意义(33.02%比20.68%,χ2=4.78,P=0.03)。结论 ULMCA末端病变采用PCI或CABG进行血管重建是安全有效的。对解剖结构适合PCI且患者拒绝或不宜行CABG的ULMCA末端病变患者来说,药物洗脱支架PCI术是一种可以选择的替代治疗方案。
Objective To investigate the effect and prognostic significance of different vascular reconstruction methods on the treatment of unprotected left main trunk (ULMCA) patients. Methods The clinical data of 222 patients diagnosed as ULMCA terminal lesions by coronary angiography were consecutively included. Among them, 106 patients were enrolled in the PCI group and 116 patients underwent coronary artery bypass grafting (CABG). Two groups The incidence of all-cause death, non-fatal myocardial infarction, target revascularization and major adverse cardiac events occurred at 12 months and 3 years in patients. The effects of different vascular reconstruction modalities on the treatment outcome of end-stage lesions of ULMCA were studied. Results During the 12-month period, the primary end-point events such as all-cause mortality and non-fatal myocardial infarction were not statistically different (χ2 = 1.05, P = 0.32 and χ2 = 1.04, P = 0.38, respectively) Vascular reconstruction and the incidence of major adverse cardiac events were statistically different (χ2 = 5.45, P = 0.02 and χ2 = 6.63, P = 0.01). After 3 years of follow-up, all-cause mortality was reduced by 33% (10.38% vs. 12.07%, χ2 = 0.47, P = 0.45) in PCI group compared to CABG group, but nonfatal myocardial infarction was 1.87 times Χ2 = 1.04, P = 0.38). The target vessel remodeling rate of PCI group was 4.17 times (20.76% vs 8.62%, χ2 = 6.63, P <0.01), while there was significant difference between the two groups in major adverse cardiac events (33.02% vs. 20.68%, χ2 = 4.78, P = 0.03). Conclusion It is safe and effective to reconstruct the end-stage lesions of the ULMCA using PCI or CABG. For patients with ULMCA-terminal lesions whose anatomy is PCI and whose patients reject or not CABG, DES is an alternative treatment option.