ABSTRACT
Objective To study the prognosis and risk factors of senile patients with unprotected left main coronary artery (ULMCA) disease treated with PCI.Methods Patients with ULMCA undergoing PCI from a single center were enrolled in the study.All patients were older than 60.The baseline characteristics were collected and the prognosis and risk factors of the patients were followed-up.All the major adverse cardiovascular and cerebrovascular events (MACCE) were evaluated throughout the follow-up period.Based on those data,Kaplan-Meier curves were plotted and Cox multivariate regression analysis was performed to assess the prognosis and identify risk factors.Results A total of 182 consecutive patients were recruited and followed up with a mean follow-up time of 21.5 (13,36.5) months and an estimated median MACCE-free survival time of 66 months by K-M method.During the follow up,all-cause mortality,non-fatal myocardial infarction,non-fatal cerebrovascular events and target vessel revascularization rates were 6.59％,0.55％,0.55％ and 15.93％ respectively,the incidence of all MACCE was 23.63％.A percentage of 72.09 of the MACCEs had occurred in the first 2 years after the PCI.According to the multivariate-adjusted Cox regression analysis,diameter of left main stent (HR =0.37,95％ CI:0.17-0.82,P =0.014),bifurcation lesion (HR =1.92,95％ CI:1.O1-3.62,P =0.045),smoking index ＞ 50pack / year (HR =3.78;95％ CI:1.29-11.05,P =0.015) were the independent risk factors of MACCE.EuroSCORE Ⅱ ≥2％ (HR =3.96,95％ CI:1.15-13.61,P =0.029) was the independent risk factor of all-cause death.Conclusion The prognosis of PCI-treated ULMCA disease is generally favorable.Most MACCEs occurred in the first 2 years after the PCI.Small left main stents diameter,bifurcation lesions,smoking index ＞ 50 pack/year and EuroSCORE Ⅱ ≥2％ were the risk factors for poor prognosis in patients with ULMCA disease.
ABSTRACT
Objective To compare the incidence of MACE and predictors in patients with unprotected left main coronary artery disease (ULMCAD) after percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). To establish a risk stratification to guide treatment and prognosis of patients with ULMCAD who underwent PCI. Methods The incidence of MACE in 201 patients with ULMCAD who underwent PCI or CABG was compared, retrospectively. The predictors of MACE of the two groups were obtained by logistic regression analyses. The predictors of MACE of the PCI group were assigned and stratified. The validity of the risk stratification on the prediction of MACE was verified in a new group of 126 patients with ULMCAD who underwent PCI. Results The incidence of MACE of PCI and CABG group was 16% and 11.9%, respectively. Logistic regression analyses showed that LVEF, diabetes mellitus and Syntax score were related to MACE in PCI group, while age, LVEF and renal function insufficiency were related to MACE in CABG group. The verification results showed a good predictive value of the risk stratification based on LVEF, diabetes mellitus and Syntax score on the incidence of MACE. Conclusions PCI treatment in patients with ULMCAD is feasible and has a good long-term outcome. The risk stratification in accordance with LVEF, diabetes mellitus and Syntax score has good predictive value on the incidence of MACE.
ABSTRACT
Coronary-artery bypass grafting(CABG)has been a standard treatment for unprotected left main coronary artery disease.Advancement in percutaneous coronary intervention(PCI)makes PCI as effective as CABG in selected patients.In this study,we assess the optimal revascularization strategy for patients with unprotected left main coronary artery disease.