冠状动脉介入治疗时代孤立性左主干狭窄病变患者的临床特征和预后分析

doi:10.3969/j.issn.1004-583X.2021.01.002

摘要/Abstract

摘要：

目的回顾性分析孤立性左主干(left main coronary artery,LMCA)狭窄病变患者的临床特征和预后。方法连续入选30例孤立性LMCA狭窄病变患者并分为两组:开口病变组(n=21)和非开口病变组(n=9)。随访终点为主要心脑血管不良事件(major adverse cardiac or cerebrovascular event,MACCE),其定义为全因死亡及需住院的心脑血管事件。结果 30例孤立性LMCA病变患者大部分接受了经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗(25/30, 83.3%),仅有2例接受冠状动脉旁路移植术,余3例仅接受了药物治疗。在中位37.0个月的随访期间内,MACCE发生率为23.3%(7/30),其中包括死亡4例。与非开口病变组相比,开口病变组女性患者更多(47.6% vs 0%,P=0.013),年龄更小(57.8±10.9 岁 vs 66.0±7.8 岁,P=0.050),MACCE发生率明显更低 (9.5% vs 55.6%,P=0.014)。结论 PCI治疗孤立性LMCA狭窄病变是一种有效、安全的治疗方法,且开口病变组较非开口病变组远期MACCE发生率低。

关键词: 冠状动脉狭窄, 左主干狭窄, 冠状动脉介入治疗, 预后

Abstract:

Objective The clinical features and prognosis of patients with isolated left main coronary artery (LMCA) were analyzed retrospectively. Methods Thirty consecutive patients with isolated LMCA stenosis were selected and divided into two groups: open lesion group (n=21) and non-open lesion group (n=9).The follow-up endpoint was major adverse cardiac or cerebrovascular event(MACCE), which was defined as all-cause death and cardiovascular and cerebrovascular events requiring hospitalization.Results Most of the 30 patients with isolated LMCA were treated with percutaneous coronary intervention (PCI)(25/30, 83.3%), only 2 patients received coronary artery bypass grafting, and the remaining 3 patients only received medication. During the median follow-up period of 37.0 months, the incidence of MACCE was 23.3%(7/30), including 4 deaths.Compared with non-open lesion group, open lesion group had more female patients (47.6% vs 0%, P=0.013), younger age (57.8±10.9 vs 66.0±7.8, P=0.050), and significantly lower MACCE incidence (9.5% vs 55.6%, P=0.014).Conclusion PCI is an effective and safe treatment for isolated LMCA stenosis, and the long-term MACCE incidence in open lesion group was lower than that in non-open lesion group.

Key words: left main coronary artery stenosis, percutaneous coronary intervention, prognosis

中图分类号:

R543.3

周靖, 戴允浪. 冠状动脉介入治疗时代孤立性左主干狭窄病变患者的临床特征和预后分析[J]. 临床荟萃, 2021, 36(1): 12-15.

Zhou Jing, Dai Yunlang. Clinical characteristics and prognosis of patients with isolated left main stenosis in coronary intervention[J]. Clinical Focus, 2021, 36(1): 12-15.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.01.002

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I1/12

图/表 5

参考文献 21

[1]	胡盛寿, 高润霖, 刘力生, 等. 《中国心血管病报告2018》概要[J]. 中国循环杂志, 2019,34(3):209-220.
[2]	何金山, 李学斌, 郭继鸿. 左主干闭塞的心电图表现[J]. 中华心血管病杂志, 2019,47(9):756-758.
[3]	郭超, 许浩博, 段欣, 等. 左主干病变导致急性心肌梗死合并心原性休克患者的近期预后[J]. 中华心血管病杂志, 2019,47(4):278-283.
[4]	Arima M, Kanoh T, Okazaki S, et al. Long-term clinical and angiographic follow-up in patients with isolated ostial stenosis of the left coronary artery[J]. Circ J, 2009,73(7):1271-1277. doi: 10.1253/circj.CJ-08-0504 URL
[5]	Koh KK, Hwang HK, Kim PG, et al. Isolated left main coronary ostial stenosis in oriental people: Operative, histopathologic and clinical findings in six patients[J]. J Am Coll Cardiol, 1993,21(2):369-373. pmid: 8426000
[6]	Velibey Y, Tusun E, Altay S, et al. Long term outcomes of surgical revascularization for isolated left main coronary artery stenosis: A single-center surveillance study[J]. Turk Kardiyol Dern Ars, 2015,43(8):684-691.
[7]	d'Allonnes FR, Corbineau H, Le Breton H, et al. Isolated left main coronary artery stenosis: Long term follow up in 106 patients after surgery[J]. Heart, 2002,87(6):544-548. pmid: 12010936
[8]	El-Menyar AA, Al Suwaidi J, Holmes DR, Jr. Left main coronary artery stenosis: State-of-the-art[J]. Curr Probl Cardiol, 2007,32(3):103-193. doi: 10.1016/j.cpcardiol.2006.12.002 URL
[9]	Srinivas SK, Sunil B, Bhat P, et al. Incidence, predictors, clinical profile, management and outcome of patients with isolated left main coronary artery ostial disease[J]. Indian Heart J, 2018,70(2):214-219. doi: S0019-4832(16)30320-0 pmid: 29716697
[10]	Martinovic I, Greve H. Surgical treatment of the isolated left ostial stenosis[J]. J Cardiovasc Surg (Torino), 2012,53(3):375-379. pmid: 22695268
[11]	Sasaguri S, Honda Y, Kanou T. Isolated coronary ostial stenosis compared with left main trunk disease[J]. Jpn Circ J, 1991,55(12):1187-1191. pmid: 1766080
[12]	Tommaso CL, Applefeld MM, Singleton RT. Isolated left main coronary artery stenosis and mediastinal radiotherapy as an etiologic factor[J]. Am J Cardiol, 1988,61(13):1119-1120. pmid: 3364367
[13]	Grollier G, Commeau P, Mercier V, et al. Post-radiotherapeutic left main coronary ostial stenosis: Clinical and histological study[J]. Eur Heart J, 1988,9(5):567-570. pmid: 3402473
[14]	Kawakami H, Matsuoka H, Koyama Y, et al. Isolated left coronary ostial stenosis as a result of fibromuscular dysplasia in a young man[J]. Jpn Circ J, 2000,64(12):988-989. pmid: 11194297
[15]	王佳旺, 曹绪芬, 徐泽升. 无保护左主干介入治疗[J]. 临床荟萃, 2019,34(1):93-96.
[16]	杨军芬, 臧雁翔, 李为民. 基于多项临床研究对左主干病变血运重建策略的思考[J]. 中国介入心脏病学杂志, 2020,28(7):406-409.
[17]	玉献鹏, 金泽宁, 李宇, 等. Pci和cabg治疗无保护左主干开口/体部病变的远期预后比较[J]. 中华心血管病杂志, 2020,48(6):484-488.
[18]	Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 esc/eacts guidelines on myocardial revascularization[J]. Eur Heart J, 2018.
[19]	中华医学会心血管病学分会介入心脏病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016)[J]. 中华心血管病杂志, 2016,44(5):382-400.
[20]	许峥贵, 钟诚, 何浪, 等. 血管内超声在冠状动脉左主干介入治疗中的临床价值[J]. 浙江医学, 2019,41(21):2309-2315.
[21]	罗永百, 黄欣, 钟钟, 等. 血管内超声指导单支架术式处理左主干分叉病变1年随访结果分析[J]. 中国介入心脏病学杂志, 2019,27(5):249-252.

项目	开口病变组(n=21)	非开口病变组(n=9)	统计值	P值
女性[例(%)]	10(47.6)	0		0.013^*
年龄(岁)	57.8±10.9	66.0±7.8	t=2.044	<0.05^*
临床表现[例(%)]				1.000^*
心肌梗死	3(14.3)	1(11.1)
心绞痛	18(85.7)	8(88.9)
危险因素[例(%)]
高血压	11(52.4)	4(44.4)		1.000^*
糖尿病	3(14.3)	2(22.2)		0.622^*
吸烟	5(23.8)	2(22.2)		1.000^*
辅助检查
LVEF(%)	60.8±9.4	64.4±13.2	t=0.871	0.391
LDL-C(mmol/L)	2.388±0.761	2.279±0.742	t=-0.363	0.719
HDL-C(mmol/L)	1.131±0.306	1.238±0.281	t=0.892	0.380
LMCA狭窄程度≥70%[例(%)]	19(90.5)	6(66.7)		0.143^*
血运重建方式 [例(%)]			χ²=2.825	0.243
PCI	18(85.7)	7(77.8)
CABG	2(9.5)	0(0)
药物	1(4.8)	2(22.2)
住院时间(d)	9(8,14)	8(6,12)	Z=-1.617	0.114
院内死亡[例(%)]	0(0)	1(11.1)		0.300^*
随访
时间 (月)	37.0(11.8, 45.0)	39.6(17.1, 53.3)	Z=-0.158	0.894
死亡[例(%)]	1(4.8)	3(33.3)		0.069^*
MACCE[例(%)]	2(9.5)	5(55.6)		0.014^*

项目	开口病变组(n=21)	非开口病变组(n=9)	统计值	P值
女性[例(%)]	10(47.6)	0		0.013^*
年龄(岁)	57.8±10.9	66.0±7.8	t=2.044	<0.05^*
临床表现[例(%)]				1.000^*
心肌梗死	3(14.3)	1(11.1)
心绞痛	18(85.7)	8(88.9)
危险因素[例(%)]
高血压	11(52.4)	4(44.4)		1.000^*
糖尿病	3(14.3)	2(22.2)		0.622^*
吸烟	5(23.8)	2(22.2)		1.000^*
辅助检查
LVEF(%)	60.8±9.4	64.4±13.2	t=0.871	0.391
LDL-C(mmol/L)	2.388±0.761	2.279±0.742	t=-0.363	0.719
HDL-C(mmol/L)	1.131±0.306	1.238±0.281	t=0.892	0.380
LMCA狭窄程度≥70%[例(%)]	19(90.5)	6(66.7)		0.143^*
血运重建方式 [例(%)]			χ²=2.825	0.243
PCI	18(85.7)	7(77.8)
CABG	2(9.5)	0(0)
药物	1(4.8)	2(22.2)
住院时间(d)	9(8,14)	8(6,12)	Z=-1.617	0.114
院内死亡[例(%)]	0(0)	1(11.1)		0.300^*
随访
时间 (月)	37.0(11.8, 45.0)	39.6(17.1, 53.3)	Z=-0.158	0.894
死亡[例(%)]	1(4.8)	3(33.3)		0.069^*
MACCE[例(%)]	2(9.5)	5(55.6)		0.014^*