未受保护的左主冠状动脉狭窄症的同时穿皮治疗:多中心注册分析的初步结果1994-1996年
S G Ellis1, H Tamai, M Nobuyoshi
1The Cleveland Clinic Foundation, Ohio 44195, USA. elliss@cesmtp.ccf.org
Circulation
|December 24, 1997
概括
通过皮肤治疗未受保护的左主 (ULMT) 冠状动脉狭窄症在选定的患者中显示出有希望的结果,但需要进一步调查,以尽量减少早期心脏病死亡. 冠状动脉旁路手术仍然是大多数患者的首选选择.
科学领域:
- 干预心脏病学 干预心脏病学
- 心血管外科心血管外科
- 医疗器械技术 医疗器械技术
背景情况:
- 冠状动脉旁路手术 (CABG) 是对无保护左主 (ULMT) 冠状动脉狭窄症的标准治疗方法.
- 新出现的数据表明,穿皮干预可能在某些特定情况下提供相似的结果.
研究的目的:
- 在多个经验丰富的中心评估皮ULMT再血管化的结果.
- 为了比较皮肤间干预措施的疗效和安全性与ULMT疾病的CABG.
主要方法:
- 从25个中心收集的数据,涉及107名连续治疗ULMT狭窄症 (选择性或急性心肌梗塞) 的患者,1994年1月1日之后.
- 主要干预包括支架,定向切除术和气球血管造形术.
- 随访完成率为98.8%,平均15个月.
主要成果:
- 对于选择性手术,技术成功率为98.9%,住院生存率与左心室喷射率 (LVEF) 相相关.
- 患有LVEF≥40%的患者在9个月后有98%的住院生存率和86%的无事件生存率.
- 患有LVEF<40%的患者的生存率显著降低 (67%在医院,22%在9个月后没有事件).
- 退院后的早期心脏病死亡发生在10.6%的幸存者中,在6个月内发生.
结论:
- 由于出院后早期心脏死亡的风险,ULMT狭窄的皮肤再血管化还不是CABG的通用替代方案.
- 定向性切除术和支架是ULMT的首选穿皮技术.
- 建议在手术后6-8周进行例行随访血管造影.
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