Clinical outcome of patients with left anterior descending artery ostial lesions treated with percutaneous coronary intervention; case-matched comparison with bypass surgery

作     者：刘品明 张少玲 FrancoisSchiele NicolasMeneveau Jean-PierreBassand 

作者机构：Department of MedicineSecond Affiliated HospitalSun Yat-sen UniversityGuangzhou 510120China Service de CardiologieCentre Hospitalier Universitaire25030 BesanconFrance 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2003年第116卷第6期

页      面：844-848页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：coronary artery disease·percutaneous transluminal coronary angioplasfy·stents 

摘      要：Objective To assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention. Methods Seventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and reguiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method). Results In the catheter-based angioplasty group, the patients mean age was 63 ? years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein Ⅱ b/ Ⅲ a antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2. 90±0. 48 mm. The minimum lumen diameter increased from 1. 05±0. 30 mm to 2.40±0. 45 mm, and the diameter stenosis decreased from 64%±7% to 8%±13%. During the follow-up period, adverse events reguiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42±0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant. Conclusions Percutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, b