Incidence, Predictors, Treatment, and Long-Term Prognosis of Patients With Restenosis After Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease
Incidence, Predictors, Treatment, and Long-Term Prognosis of Patients With Restenosis After Drug-Eluting Stent Implantation for Unprotected Left Main Coronary Artery Disease
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DOI：
10.1016/j.jacc.2010.10.041
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发表时间：
2011-03-22
影响因子：
24
通讯作者：
Park, Seung-Jung
中科院分区：
文献类型：
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作者：
Lee, Jong-Young;Park, Duk-Woo;Park, Seung-Jung
目的本研究的目的是评估乳腺癌的发病率、预测因素，无保护左主干（LMCA）经皮冠状动脉介入治疗（PCI）后药物洗脱支架（DES）支架内再狭窄（ISR）患者的长期结局关于DES治疗无保护LMCA疾病后发生再狭窄患者的临床过程和管理的数据很少。2003年2月至2007年11月，509例无保护LMCA疾病的连续患者接受了DES植入术，其中402例（80.1%）接受了常规监测或临床驱动的血管造影随访。主要不良心脏事件定义为死亡、心肌梗死（MI）或靶病变血运重建的复合事件。结果LMCA病变血管造影ISR的总发生率为17.6%（71/402例患者，57例为局灶型ISR，14例为弥漫型ISR）。40例患者（56.3%）接受了重复PCI，10例（14.1%）接受了旁路手术，21例（29.6%）接受了药物治疗。在长期随访期间（中位数为31.7个月），无死亡，1例（2.2%）MI和6例（9.5%）重复靶病变血运重建病例。药物组、重复PCI组和旁路手术组的主要不良心脏事件发生率分别为14.4%、13.6%和10.0%（p = 0.91）。多因素分析显示，DES-ISR的发生并不影响死亡或心肌梗死的风险。结论LMCA DES支架植入后ISR的发生率为17.7%。与LMCA支架植入术相关的DES-ISR患者的长期临床预后可能是良性的，因为这些患者根据主治医生的临床判断进行了最佳治疗。（J Am科尔心脏病学杂志2011; 57：1349 - 58）（C）美国心脏病学会基金会2011年
Objectives The aim of this study was to evaluate the incidence, predictors, and long-term outcomes of patients with in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) for unprotected left main coronary artery (LMCA) disease.Background Few data on the clinical course and management of patients experiencing restenosis after DES treatment for unprotected LMCA disease have appeared.Methods Between February 2003 and November 2007, 509 consecutive patients with unprotected LMCA disease underwent DES implantation, with 402 (80.1%) undergoing routine surveillance or clinically driven angiographic follow-up. A major adverse cardiac event was defined as the composite of death, myocardial infarction (MI), or target-lesion revascularization.Results The overall incidence of angiographic ISR in LMCA lesions was 17.6% (71 of 402 patients, 57 with focal-type and 14 with diffuse-type ISR. Forty patients (56.3%) underwent repeated PCI, 10 (14.1%) underwent bypass surgery, and 21 (29.6%) were treated medically. During long-term follow-up (a median of 31.7 months), there were no deaths, 1 (2.2%) MI, and 6 (9.5%) repeated target-lesion revascularization cases. The incidence of major adverse cardiac event was 14.4% in the medical group, 13.6% in the repeated PCI group, and 10.0% in the bypass surgery group (p = 0.91). Multivariate analysis showed that the occurrence of DES-ISR did not affect the risk of death or MI.Conclusions The incidence of ISR was 17.7% after DES stenting for LMCA. The long-term clinical prognosis of patients with DES-ISR associated with LMCA stenting might be benign, given that these patients were optimally treated with the clinical judgment of the treating physician. (J Am Coll Cardiol 2011; 57: 1349-58) (C) 2011 by the American College of Cardiology Foundation