Clinical Outcomes Of Percutaneous Coronary Intervention For Left Main Coronary Artery Stenosis

Objective:To observe on the clinical characteristics of left main coronary artery stenosis and compare the effect of two clinical therapies including PCI and CABG.Methods:From May 2005 to October 2008,a total of 30 left main coronary artery stenosis patients undergone PCI were admitted to the Department of cardiology in the First affiliates hospital of Kunming medical college and the third people's hospital of Yunnan province and other hospitals of city and county.As control,a total of 16 left main coronary artery stenosis patients undergone CABG were admitted to the Department of cardiac surgery in the First affiliate hospital of Kunming medical college from March 2007 to October 2008.The clinical and CAG informations were collected and studied,including general condition(gendex,age,heiqht,weight,CAD,etal).biochemical index,the cardiac function,ECG,CAG.treatment with CABG or PCI.The follow-up was carried out in April 2009.Outcomes were obtained by chart record review and telrphone,the major adverse cardiac events(MACE, including death,MI,and TVR),angina and the major adverse cardiac cerebrovascular events(MACCE,including death,MI,TVR and cerebrovascular events) were observed.Results:①comparison of clinical data:NO obvious difference was observed in the two groups in whole.Thrombin time for the group significantly differed from that of the CABG group(20.85±7.6 VS 16.35±3.20,P＜0.05).LVEF for the PCI group significantly differed from that of the CABG group(57.41%±8.31%VS 51.25%±8.54%,P＜0.05).There was sighificant improvement after operation in the PCI group on LVEE NO obvious difference was observed in the two groups on EUROscore,Parsonnet score and SYNTAX score,with score increasing,MACCE were also increased.②Outcomes of CAG:The 3 grade as well as distal bifurcation stenosis had 5 (16.7%) and 8(50.0%) in the PCI group and CABG group,respectively,P＜0.05. Ostium lesion had 43.0%and 4.3%in the hospitals of city and county and in the First affiliates hospital of Kunming medical college and the third people's hospital of Yunnan province,respectively,P＜0.05.Left main coronary artery stenosis patients with distal bifurcation stenosis had 28.5%and 82.7%in the hospitals of city and county and in the First affiliates hospital of Kunming medical college and the third people's hospital of Yunnan province,respectively,P＜0.05.③Results of PCI:In PCI group(n=30),the average size of stenting was(3.5±0.5×19.0±6.5)mm,the average release pressure was(18±4)arm.The success rate of left main coronary artery stents implantation were 100%,The success rate of coronary artery stents implantation also were 100%.17 patients undergoing PCI were belong to group ACS,13 patients undergoing PCI were belong to group non-ACS.The IABP were applied in 2 patients undergoing PCI.The IVUS were applied in 1 patients undergoing PCI.④Follow-up results:No significance was concluded about the recent effect among this two different therapies.At long term,the rate of recurrent angina pectoris and MI had no difference in the PCI group and CABG group(15.6%VS 25.0%,P＞0.05and 9.4%VS 0.0%.P＞0.05),the revascularization was 12.5%and 6.3%(P＞0.05)in group PCI and CABG,respectively.The rate of the incidence of major adverse cardiac events(MACE)were 25.0%and 12.6%(P＞0.05)in group PCI and CABG,respectively.The incidence of major adverse cardiac cerebrovascular events(MACCE) were 28.3%and 12.6%(P＞0.05)in group PCI and CABG, respectively.In the long-term effect,the rate of recurrent angina pectoris and MACE had significant difference in the ACS group undering PCI and non-ACS group undering PCI(29.4%VS 0%,P＜0.05 and 41.2%VS 7.6%,P＜0.05), respectively. Conclusion:1.Comparing CABG,stenting for selected patients with unprotected LMCA stenosis is feasible and safe and had good relent and long term effects.2.One of main effect factors was acute coronary syndrome on the rate of recurrent angina pectoris and the incidence of major adverse cardiac cerebrovascular events.3.The rate of usage of IABP was associated with left main coronary artery bifurcation lesions.It was high risk that left main coronary artery bifurcation lesions was implanted stents.