目的 探讨药物洗脱支架(drug-eluting stent,DES)治疗冠状动脉无保护左主干(unprotected left main artery,ULM)病变远期临床效果.方法 回顾性分析211例冠心病ULM病变患者临床特点,并观察置入DES后远期主要心脑血管事件(major adverse cardiac and cerebral events,MACCE)发生情况.结果 211例ULM病变患者中不稳定型心绞痛145例(68.7%),ULM病变在远段分叉部占75.4%,151例(71.6%)ULM患者存在多支病变.单支架治疗分叉病变119例(74.8%).平均随访(28.9±11.8)个月.38例(18.0%)发生MACCE,23例(10.9%)靶血管再次血运重建,10例(4.7%)心肌梗死,3例(1.4%)脑卒中,9例(4.3%)死亡.远段与非远段ULM病变DES治疗后远期MACCE发生率比较,差异无统计学意义(Log-rank P=0.62).单支架与双支架治疗左主干远段病变DES治疗后远期MACCE发生率比较,差异无统计学意义(Log-rank P=0.795).合并2型糖尿病ULM病变DES治疗后远期MACCE发生率明显高于单纯ULM患者,差异有统计学意义(Log-rank P=0.026).结论 对冠状动脉ULM病变选择性使用DES行介入治疗安全有效,远期疗效良好.2型糖尿病是ULM病变支架术后远期MACCE的独立预测因子.%Objective To evaluate the long - term clinical outcomes after implacement of drug - eluting stent in patients with unprotected left main coronary artery ( ULMCA ) disease. Methods PCI with DES was performed in 211 consecutive patients with ULMCA disease between september 2006 and march 2010, with the long - term clinical outcomes studied. Results Of the 211 ULM patients, 145 ( 68.7％ ) were with unstable angina and 75.4％ of the cases were with distal ULM, multivessel c:oronary disease were noticed in 151 ( 71.6％ ) cases. Single stent was applied in 119 ( 74.8％ ) for distal ULM patients. All patients were followed up for an average of ( 28.9 ± 11.8 ) months. Major adverse cardiac or cerebrovascular events ( MACCE ) were seen in 38 ( 18.0％ ) patients. There were 9 ( 4.3％ ) cases of deaths, 10 ( 4.7％ ) of myocardial infarction ( MI ), 23 ( 10.9％ ) of target vessel revascularization, and 3 ( 1.4％ ) of cerebrovascular events. MACCE occurrence rates were similar between distal and no - distal ULM patients ( Log - rank P =0.62 ) . No significant statistical differences existed in MACCE occurrence rate between single - stent and two - stent technology in treating distal ULM ( Log - rank P =0.795 ) . Compared with non-diabetic ULM patients, the rate of MACCE was significantly higher in ULM patients with complicated type -2 diabetes ( Log -rank P=0.026 ) . Conclusion The present study demonstrates that PCI with drug - eluting stent implacement is a safe and effective method in treatment of unprotected left main coronary artery disease. Diabetes mellitus is among the independent predictors of MACCE following coronary stenting in ULM patients.
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