Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study.
Impact of lesion morphology and associated procedures for left main coronary stenting on angiographic outcome after intervention: sub-analysis of Heart Research Group of Kanazawa, HERZ, Study.
复制标题
病变形态和左主冠状动脉支架置入术相关手术对干预后血管造影结果的影响：金泽心脏研究组的亚分析，HERZ，研究。
DOI：
10.1007/s12928-013-0222-8
复制
发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Yamagishi M.
中科院分区：
文献类型：
--
作者：
Kawashiri MA;Sakata K;Uchiyama K;Konno T;Namura M;Mizuno S;Tatami R;Kanaya H;Nitta Y;Michishita I;Hirase H;Ueda K;Aoyama T;Okeie K;Haraki T;Mori K;Araki T;Minamoto M;Oiwake H;Ino H;Hayashi K;Yamagishi M.
冠状动脉左主干病变的病变形态和相关的介入治疗是否会影响临床结果仍存在争议。因此，我们研究了病变形态和相关手术对LMCA支架植入术的临床和血管造影结局的影响。在登记的7,660例冠状动脉介入治疗患者中，我们分析了228例（179例男性，平均年龄69.4岁）与LMCA病变有关的早期血管造影结果。在228例有长期血管造影结果的患者中，我们检查了121例主要不良冠状动脉事件（MACE）的发生率，特别是在急性冠状动脉综合征（ACS）的存在、支架类型、金属或药物洗脱支架、病变形态和相关手术方面。LMCA支架植入术的早期血管造影成功率为100%，临床成功率为94.3%。随访3年，17例发生MACE。在这些条件下，多重支架植入术（p< 0.01）和复杂手术如Y型支架、T型支架和挤压支架（p< 0.01）被列为MACE的风险，尽管支架类型之间没有统计学差异。多因素分析显示，复杂操作使用金属支架对MACE的发生有显著不利影响（p< 0.01）。这些结果表明，复杂的手术对LMCA病变支架植入后的临床和血管造影结局有很大影响，并建议在本队列中使用单枚支架的简单手术治疗LMCA病变。ACS的存在是否会影响预后还有待进一步研究。
Whether the lesion morphology and associated interventional procedures for the left main coronary artery disease (LMCA) could affect clinical outcome is still controversial. Therefore, we examined the impact of lesion morphology and associated procedures on clinical and angiographic outcomes of stenting for the LMCA. Among 7,660 patients with coronary intervention registered, we analyzed early angiographic results of 228 patients (179 men, mean age 69.4 years) concerned with LMCA lesions. In 121 out of 228 patients having long-term angiographic results, we examined the occurrence of major adverse coronary events (MACE) particularly in terms of the presence of acute coronary syndrome (ACS), the kind of stents, bear metal or drug eluting, the lesion morphology and associated procedures. Early angiographic success rate of LMCA stenting was 100 %, and clinical success rate was 94.3 %. During follow-up period for 3 years, MACE was observed in 17 patients. Under these conditions, multiple stenting (p< 0.01) and complicated procedures such as such as Y-stent, T-stent and crush stent (p< 0.01) were listed as risks for MACE, although there was no statistical difference in kinds of stent. Multivariate analysis demonstrated the significant disadvantage of complicated procedures using the bear metal stent on the occurrence of MACE (p< 0.01). These results demonstrate that the complicated procedures have great impact on clinical and angiographic outcomes after stenting for LMCA lesions, and suggest the simple procedure with a single stent for LMCA lesions in the present cohort. Whether the presence of ACS can affect the prognosis should further be sought.