| Objective To evaluate the short and long term outcomes of unprotected left main coronary artery lesions(ULMCA)stenting and determine the factors which affect the main adverse cardiac events(MACE),we aimed to confirm the safety and efficacy of stenting in ULMCA.To evaluate the factors of restenosis by the follow-up angiographical results,and analyse the influence of intravascular ultrasound(IVUS)in ULMCA intervention.Materials and Methods 150 patients who underwent ULMCA stenting from April 2003 to June 2008 were enrolled.According to left main coronary artery lesions location,they were assigned to non-bifurcation lesion group(n=35)and distal bifurcation lesion group(n=115),which involved respectively lesions in ostial or shaft part and distal part or anterior descending branch or circumflex branch ostial.To analyse the risk factors of MACE and survival rate of non-cardiac events by comparing the difference between two groups in basic clinical data,coronary angiography data,the MACE of in-hospital and follow-up.To analyse the follow-up angiographical results of the mean 10 months of 48 patients,they were assigned to restenosis group(n=12)and non-restenosis group (n=36),according to whether stenosis rate of stents internal diameter or 5mm range in circum-stents is greater than 50%or not.To analyse the detailed coronary angiography result of the restenosis group,we compared the difference between this two groups in basic clinical data,coronary angiography data and treatment date.This study also found some ostium of left circumflex branch(LCX) stenosis,and then analysed the reasons of this phenomenon.We analysed the 44 patients who were guided by IVUS,the influence of different lesion sites on plaque character,the IVUS date of different stent technique,the comparion of IVUS and coronary angiography and the impact of IVUS in unprotected LMCA intervention.Results Our clinical follow-up time was 1 to 43(9.86±8.46) months,125(84.45%)patients were successfully followed up.Men and hyperlipidemia in the distal bifurcation lesion group were more than which in non-bifurcation lesion group(85.22%vs 65.71%p=0.0105;35.65%vs 17.14%p=0.0387).The stent diameter(3.63±0.41mm vs 3.49±0.35 mm,p=0.0486) and acute gain(2.02±0.7mm vs 1.67±0.87mm,p=0.0313) in non-bifurcation lesion group were larger than which in bifurcation lesion group.The lcx stenosis(31.30%vs 14.29%,p=0.0479) and follow-up coronary angiography(36.52%vs 17.14%,p=0.0314) in bifurcation lesion group were more than which in non-bifurcation lesion group.The two groups had no significant difference in the in-hospital MACE.Angina pectoris in the distal bifurcation lesion group were more than which in non-bifurcation lesion group (33.68%vs 13.33%,p=0.0467)during the follow-up,but follow-up MACE had no significant difference.Single-variable analysis showed MACE in IVUS guided group had less than which in non-IVUS guided group(4.17%vs 17.65%,p=0.0446).The survival analysis of Kaplan-Meier showed that the survival rate of non-cardiac events after PCI 6 months,12 months,24 months were 91.42%,79.34%,72.12%,respectively.By comparing between non-restenosis group and the restenosis group in the follow-up angiographical results,the minimal lumen diameter(2.71±0.95mm vs 3.54±0.43mm,p=0.0001),the rate of diameter stenosis(31.4±26.41%vs 8.26±5.28%,p=0.0000),late loss(0.79±0.73mm vs 0.16±0.25mm,p=0.0000) and stent technique in the two groups were different significantly.Restenosis rate of the two stent technique was greater than which of one stent technique(75%vs 13.89%,p= 0.0011).The difference of two stent technique was not significant,the difference of stent kinds showed the restenosis rate of endeavor was higher than cypher. Analyse the 25 crossover stent which caused LCX ostium stenosis,there were no influence significantly in two guidewire protecting,predilation and final kissing.Soft plaque in the non-bifurcation lesion group was greater than which in bifurcation lesion group(50%vs 7.14%,p=0.0393),the angiographical date was smaller than the IVUS date in the minimal lumen diameter(1.72±0.62mm vs 2.27±0.38mm,p=0.0001),minimal lumen area(2.62±1.87mm~2 vs 4.93±1.63 mm~2,p=0.0000),but the rate of area stenosis(78.08±7.31%vs 64.53±9.18%,p=0.0000)was larger,the stent diameter in the angiography group was smaller than which in IVUS group(3.46±0.36mm vs 3.75±0.26mm,p=0.0005). Angina pectoris(15.91%vs 35.8%,p=0.019),TLR(0%vs 16.05%,p=0.0124) and MACE(2.27%vs 19.75%,p=0.0143) in the IVUS guided group were less than which in non-IVUS guided group.Conclusion The distal bifurcation lesion group had more angina pectoris than non-bifurcation lesion group during the follow-up,but they had no difference significant in the follow-up MACE,non-IVUS guided may be one of the influencing factors of MACE.The two stent technique had more restenosis rate than one stent technique by the follow-up angiographical results,the difference of two stent technique was not significant,the difference of stent kinds showed the restenosis rate of endeavor was higher than cypher.IVUS guided group had less angina pectoris, TLR and MACE than non-IVUS guided group.
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