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Study of Drug-Eluting Stents in Treatment of Unprotected Left Main Coronary Artery Disease

Author: ZhuHaiJun
Tutor: CuiLianQun
School: Shandong University
Course: Internal Medicine
Keywords: Coronary atherosclerotic heart disease Percutaneous coronary intervention in patients Unprotected left main coronary artery disease Drug-eluting stents Syntax Credits
CLC: R541.4
Type: Master's thesis
Year: 2011
Downloads: 23
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Abstract

Objective: To observe and analyze drug-eluting stent treatment efficacy and safety of unprotected left main coronary artery disease; observed unprotected left main coronary artery disease patients after interventional treatment of all-cause death, myocardial infarction, cerebrovascular events, target vessel revascularization the occurrence of major adverse cardiac and cerebral vascular events; prognosis of patients with different lesion characteristics, as well as different stent technology's impact on the prognosis. Subjects and methods: The study subjects from July 2004 to December 2009, the Shandong Provincial Hospital, Department of Cardiology line drug eluting stents (DES) treatment in patients with unprotected left main coronary artery disease (ULMCAD). Collect collate clinical data, including the general condition of the patients, coronary heart disease risk factors, laboratory biochemical markers, ECG, and echocardiography examination. Whether multivessel disease involving the left anterior descending artery, the circumflex artery or right coronary artery divided into groups (left main disease merger of two or three-vessel disease) according to coronary artery disease and non-vessel disease group (single branch isolated left main disease or merger vascular disease); patients with left main lesion is divided into non-bifurcation lesions and bifurcation lesions; bifurcation lesions group the different interventional surgical divided into single stent subgroup and double stent technology subgroups. The and application Syntax integral method for risk stratification (Syntax integral lt; 33 is divided into low and medium-risk group, Syntax Credits ≥ 33 minutes of high-risk groups). The patients were followed up regularly to track the occurrence of all-cause death, myocardial infarction, cerebrovascular events, target vessel revascularization, major adverse cardiac and cerebrovascular events (MACCE). The compare different lesions characteristic group and the different interventional surgical group clinical data and MACCE incidence differences. Results: Total elected to the 76 patients, age 40-78 (61.6 ± 9.5) years old, male 52 cases (68.4%). Hypertension, 45 cases (59.2%), diabetes mellitus in 14 patients (18.4%), dyslipidemia in 47 cases (61.8%), long-term heavy smokers of 37 cases (48.7%), obesity in 15 cases (19.7%), family history of CAD in 9 patients (11.8%). 2. Coronary angiography showed non multivessel disease group of 36 patients, the group of 40 patients with multivessel disease. Non-bifurcation lesions in 14 cases, 62 cases of bifurcation lesions. Use in bifurcation lesions the the single stent technology 29 cases; 33 cases of double stent technology, including nine cases of Crush Technique Mini-crush technology 18 cases, T stent technology 4 cases, 2 cases of modified T stent technology. Placed a total of 216 drug-eluting stents, surgical success rate of 100%. During hospitalization without MACCE occurred. Follow-up 12-78 (34.9 ± 16.6) months, all-cause death in 3 cases, myocardial infarction, 4 cases; 29 patients underwent coronary angiography, restenosis eight cases, which again line PCI 7 cases, coronary artery bypass grafting surgery (CABG) 1 cases. 1 year MACCE10 cases (13.2%) were followed up the endpoint total MACCE15 patients (19.7%). Non multivessel disease group compared with multivessel disease was no significant difference in the incidence of 1-year MACCE (5.6% vs 20.0%, P gt; 0.05); follow-up endpoint total MACCE incidence of multivessel disease group was significantly higher than the non- multivessel disease group (30.0% vs 8.3%, P lt; 0.05). The group of non-bifurcation lesions and bifurcation lesions compared with 1-year of MACCE and follow-up endpoint total MACCE occurrence rate was no significant difference (0.0% vs. 16.1%; 7.1% vs 22.6%, P are gt; 0.05). Bifurcation lesions in single stent technology subgroup 1 year of MACCE and follow-up endpoint total MACCE incidence was significantly lower than the double stent subgroup (3.4% vs. 27.3%; 10.3% vs 33.3%, JP, lt; 0.05). MACCE incidence difference between Syntax integral high-risk group and the low-risk group in 1 year was not statistically significant (27.8% vs 8.6%, P gt; 0.05); in the the MACCE incidence of high-risk end of follow-up group was significantly higher than the low-risk group (44.4% vs 12.1%, P lt; 0.05). COX regression analysis showed that The Syntax score ≥ 33 ULMCAD stenting in patients with MACCE independent predictive factors. Conclusion: drug-eluting stents for unprotected left main coronary artery disease have better short-term and long-term efficacy; merge in patients with multivessel disease and bifurcation lesions in patients with poor prognosis, especially line double stent-treated patients; Target vessel revascularization reconstruction is the most important adverse events after stenting; Syntax score ≥ 33 is an independent predictor of protected left main disease patients after stenting major adverse cardiac and cerebrovascular events.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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