摘要
目的:观察左冠状动脉主干病变(LMCA)患者的临床特征,并比较药物治疗、经皮冠状动脉介入术(PCI)及冠状动脉旁路移植术(CABG)这三种治疗方法的近期及远期疗效。方法:回顾性收集2007年1月～2009年6月在我院住院治疗的保存完整的72例LMCA患者的临床资料及CAG结果。根据左主干管径狭窄程度定50%～69%为Ⅰ级病变,70%～89%为Ⅱ级病变,90%～99%为Ⅲ级病变,100%完全闭塞为IV级病变。根据其他冠脉受累情况分为:单纯左主干组、左主干+1支组、左主干+2支组及左主干+3支组。2009年11月～12月对上述患者进行了随访,观察死亡、非致死性心肌梗死、再次进行冠脉血运重建术等终点事件的发生情况及心绞痛复发情况。结果:①临床资料比较:左主干病变总的心绞痛发生率为83.3%,各组比较差异无显著性(P>0.05)。心肌梗死发生率为59.7%,LM并3支组与其余各组比较差异有显著性(P<0.05),单纯LM组射血分数明显高于LM并3支组(P<0.01)和LM并2支组(P<0.05);②.单纯左主干组6例(8.3%),左主干+1支组6例(8.3%),左主干+2支组11例(15.3%),左主干+3支组49例(68.1%)。左主干Ⅰ级病变32例(44.4%),II级病变21例(29.2%),Ⅲ级病变18例(25%),完全闭塞1例;③.近期疗效:药物治疗、PCI及CABG组之间差异无显著性(P>0.05)。远期疗效比较:血运重建组的死亡率和心肌梗死发生率显著低于药物治疗组(P<0.05)。PCI与药物治疗两组间的血运重建率没有差异(P>0.05),这两组的血运重建率明显高于CABG组(P<0.05)。心绞痛复发的情况,PCI及CABG组与药物治疗组比较有显著性差异(P<0.05)。结论:经过选择的无保护LMCA病变支架置入术是可行和安全的,并可取得较好近、远期疗效。冠状动脉血运重建,无论是PCI还是CABG对于左主干病变均比单纯药物治疗有延长寿命,减少远期终点事件的作用。
Objective:To observe the clinical characteristics of left main coronary artery stenosis(LMCA) and to compare the effect of three therapies including standard drug therapy,PCI and CABG.Methods:From January 2007 to June 2009,a total of 72 LMCA patients were admitted to the department of cardiology in shangdong provincial Hospital.The clinical and CAG information were collected and studied.The follow-up was carried out from November to December in 2009,and the major adverse cardiac events including death,MI and revascularization was observed.Results:① Comparison of clinical data: the prevalence of angina was 83.3%,no obvious difference was observed among the four groups.The prevalence of MI was 59.7%.There was obvious difference between three-vessel stenosis LM group and the other groups.The LVEF in isolated LM group was obviously high than two-vessel stenosis LM group and three-vessel stenosis LM group;② There were 6 patients(8.3%) in isolated LM group,6 patients(8.3%) in one-vessel stenosis LM group,11 patients(15.3%) in two-vessel stenosis LM group and 49 patients(68.1%) in three-vessel stenosis LM group.There were 32 patients(44.4%) in class I LM stenosis group,21 patients(29.2%) in Class II LM stenosis group,18 patients(25%) in Class III LM stenosis group and total occlusion in 1 patient;③ No significance was concluded about the recent effect among these three different therapies;At long term,the incidence of death and MI was lower in revascularization group than standard drug therapy group.The incidence of revascularization was not different in PCI and standard drug therapy groups,but CABG group was lower.The incidence of angina recurrence was lower in the group of PCI and CABG than that in the group of medicine therapy.Conclusion:Stenting for selected patients with unprotected LMCA stenosis is feasible and safe and has good recent and long term effects.Revascularization can prolong life and reduce major adverse cardiac events in the long term.
出处
《医学影像学杂志》
2010年第12期1794-1798,共5页
Journal of Medical Imaging
关键词
左冠状动脉主干病变
经皮冠状动脉介入术
冠状动脉旁路移植术
药物治疗
随访
Left main coronary artery stenosis
Percutaneous coronary intervention
Coronary artery bypass grafting
Medicine therapy
Follow-up
