论文部分内容阅读
目的:评估药物洗脱支架(DES)置入与冠状动脉旁路移植术(CABG)治疗无保护左主干病变的临床疗效。方法:分析2003-10-2010-09期间行血运重建的282例无保护左主干患者的临床资料,其中接受DES者143例(DES组),接受CABG者139例(CABG组),比较2组住院期和随访期心脑血管不良事件(死亡、非致死性心肌梗死、脑卒中和再次血运重建,即MACCE)的发生情况。结果:DES组手术成功率为100%,住院期间1例发生非致死性心肌梗死,无一例死亡、脑血管意外或需再次血运重建;CABG组手术成功率为95.7%,住院期间有1例发生非致死性急性心肌梗死,无一例需再次血运重建,共有6例死亡;CABG组住院期死亡率明显高于DES组(4.3%∶0,P<0.05),住院期CABG组总MACCE发生率也明显高于DES组(5.0%∶0.7%,P<0.05);随访期平均(17±8)个月,DES组临床心绞痛复发率和再次血运重建率较CABG组有增高趋势(7.8%∶2.7%,7.0%∶1.8%),但差异无统计学意义,其总MACCE发生率显著高于CABG组(14.8%∶7.1%,P<0.05);剔除新发病变及病变进展病例后,2组总MACCE发生率(7.8%∶7.1%)差异无统计学意义。结论:DES治疗无保护左主干病变安全和有效,可以作为CABG的一种替代治疗手段。
Objective: To evaluate the clinical efficacy of drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in the treatment of unprotected left main disease. METHODS: The clinical data of 282 unprotected left main patients who underwent revascularization during 2003-10-2010-09 were analyzed. Of the 143 patients who received DES, 143 received DES (DES) and 139 received CABG (CABG) compared with 2 Cardiac and cerebrovascular adverse events (death, non-fatal myocardial infarction, stroke, and revascularization, MACCE) were observed during the hospitalization and follow-up periods. Results: The success rate of operation in DES group was 100%. One case of non-fatal myocardial infarction occurred during hospitalization, and no death, cerebrovascular accident or revascularization was required. The success rate of operation in CABG group was 95.7% and in hospital one case In non-fatal acute myocardial infarction, none of the patients needed revascularization again. There were 6 deaths in total. The in-hospital mortality rate in CABG group was significantly higher than that in DES group (4.3%: 0, P <0.05) The rates of clinical angina recurrence and revascularization in DES group were significantly higher than those in CABG group (7.8% vs 0.7%, P <0.05) The incidence of MACCE was significantly higher than that of CABG group (14.8%, 7.1%, P <0.05). After excluding the newly diagnosed and pathologically advanced cases There was no significant difference in the incidence of MACCE between the two groups (7.8% vs 7.1%). Conclusions: DES is safe and effective in the treatment of unprotected left main trunk disease and may serve as an alternative treatment for CABG.