Study Of Drug-Eluting Stents In Treatment Of Unprotected Left Main Coronary Artery Disease

Objective:To observe and analyze the validity and safety of drug-eluting stents (DES) for patients with unprotected left main coronary artery disease (ULMCAD), observe the rate of the major adverse cardiac cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI). To compare the prognosis of groups with different coronary angiographic features and the influence of different PCI technique.Methods:The clinical data of patients with ULMCAD treated by DES in the department of Cardiology of Shandong Provincial Hospital from July 2004 to December 2009 were analyzed retrospectively. The collected clinical data involved general state of health, risk factors of coronary artery disease, biochemical indicators, ECG and ultrasound of cardiology. According to the coronary angiographic features the patients were divided into different groups:multivessel disease (MVD) group and non-multivessel disease (NMVD) group; bifurcation lesions group and non-bifurcation lesions group. Bifurcation lesions group were divided into single stent and double stents sub-groups according to intervention technique. The Syntax score was used on the risk stratification (Syntax score<33 as the low-risk group, and Syntax score>33 as the high-risk group). All the patients were followed-up after PCI and the MACCE of those patients including all-cause mortality, myocardial infarction, cerebrovascular events and target vessel revascularization (TVR) were observed. The difference of clinical data and MACCE rate were compared in different lesions groups and different intervention technique groups.Results: ①A total of 76 patients were selected, the mean age was 61.6±9.5 years old, and 52(68.4%) patients were male.45(59.2%) patients were suffered from hypertension, and 14(18.4%) patients were suffered from type-2 diabetes mellitus.47(61.8%) patients performed abnormal lipidemia and 37(48.7%) patients were smokers for long time.15(19.7%) patients were overweight and 9(11.8%) patients had the family history of coronary artery disease (CAD).②According to the coronary angiographic features there were 36 patients in the NMVD group and 40 patients in the MVD group; and there were 14 patients with non-bifurcation lesions and 62 patients with bifurcation lesions. In bifurcation lesions group 29 patients were treated with single stent technique and 33 patients with double stents technique. Crush stenting in 9 patients, Mini-crush stenting in 18 patients, T stenting in 4 patients and modified T stenting in 2 patients. 216 drug-eluting stents were deposited in patients. Angiographic success was achieved in 100%.③There was no MACCE in hospital. At 12-78(34.9±16.6) months,3 patients died and myocardial infarction occurred in 4 patients. Follow-up angiography was performed in 29 patients. Restenosis was detected in 8 patients, all of them underwent target vessel revascularization (7 patients underwent repeat PCI and one underwent coronary artery bypass grafting). The one-year MACCE was 13.2% and the total MACCE was 19.7%.④There is no significant difference in the one-year MACCE between the NMVD group and MVD group(5.6% vs 20.0%, P>0.05); but the difference is significant in the total MACCE between the two groups (8.3% vs 30.0%, P<0.05).There is no significant difference in the one-year MACCE and total MACCE between the bifurcation lesions group and non-bifurcation lesions group(16.1% vs 0.0% and 22.6% vs 7.1%, P>0.05). The one-year MACCE and total MACCE of single stent group is significantly lower than double stents group (3.4% vs 27.3% and 10.3% vs 33.3%, P<0.05). There is no significant difference in the one-year MACCE between the high-risk group and low-risk group(27.8% vs 8.6%, P>0.05); However, the difference is significant in the total MACCE between the two groups (44.4% vs 12.1%,P<0.05).The COX regression shows Syntax score≥33 is independent predictor of MACCE.Conclusions:PCI with DES is valid and safe in patients with ULMCAD; the early and long-term outcomes are acceptable. There is poor prognosis in patients with multivessel disease or bifurcation lesions, and the prognosis is worse in patients who underwent double stents technique.And TVR is the mian constituent part of MACCE. Syntax score≥33 is independent predictor of MACCE after PCI.