Clinical Outcome For The Percutaneous Coronary Intervention Treatment Of Unprotected Left Main Coronary Artery Disease

Objective: To observe on clinical curative effect of the patients with unprotected left main coronary artery disease by the means of comparison between the two revascularization of percutaneous coronary intervention ( PCI) and coronary artery bypass graft (CABG) .Methods: From October 2008 to August 2010 ,the patients with coronary artery sclerosing heart disease (CHD) patients were admitted to the department of cardiology in the first affiliates hospital of Shanxi medical university and were examined by the method of coronary angiography (CAG).they were diagnosed as unprotected left main coronary artery disease . According to the clinical situation and the SYNTAX score and EUROscore integration ,all patients were done a comprehensive assessment and divided into low-risk patients and mid-risk and a high-risk . Low-risk patients were suggested to carry out percutaneous coronary intervention (PCI) and high-risk patients were suggested rein to coronary artery bypass operation (CABG) treatment. As control, a total of 18 unprotected left main coronary artery stenosis patients admitted to the cardiovascular surgery in our hospital were undergone coronary bypass operation treatment from June 2007 to 2010 August. The clinical data of them were obtained by finding medical records, and analysis of these data and evaluate by the SYNTAX score and EUROSCORE .Two groups of patients were followed up by the telephone and clinic for more than 6 months to observe the incidence of MACE, including cardiac death, non fatal myocardial infarction, cerebrovascular events, target vessel revascularization (TVR), recurrent angina pain, and so on. In the period, the patients with recurrence of angina symptoms were recommended to exam by the CAG. Finally, clinical data and follow-up results were statistically analyzed.Results: In the hospitalized patients of coronary heart disease, the 29 ULMCA patients were diagnosed by coronary angiography. Based on the clinical situation and the SYNTAX score and EUROscore, integrated assessment points to the result that low-risk and mid-risk patients in 23 cases and 6 cases of high risk patients. Three of the High-risk patients screamed for the PCI treatment, because their clinical conditions can still be well, and LVEF> 40%, were agreed to their request. In the low and medium risk patients, one case was not willing to accept intervention but requiring medical conservative treatment. Results, a total of 25 patients were enrolled into the PCI group. The average left ventricular ejection fraction (LVEF) in all patients was 56.43±11.12%, SYNTAX score was 21.4±9.2 points and EUROscore integral average of 3.5±2.9 points, which left main coronary artery ostial disease in 7 cases, body lesions in 3 cases, the distal bifurcation stenosis have 4 cases involving the opening paragraph of the LAD lesion and 1 case in only the LCX, and have 3 case involved in both LAD and LCX, neither has 2 cases. But among the patients, the ejection fraction of 3 cases with multiple vessel disease is more than 40%. Surgical stent were 37 in total, and all of them were drugs-eluting stent (DES) (rapamycin and its derivatives). The immediate success rate of surgery was 100% and in-hospital major adverse cardiovascular events (MACE) did not occur during hospitalization. The angina attacks for all patients were reduced to varying degrees and left ventricular ejection fraction were increased to 6-11%, the average was 9.4%. During follow-up period 3 patients had angina pectoris, but coronary angiography showed blood flow was unobstructed and no restenosis in-stent, and found no dead, non-fatal myocardial infarction cases. In CABG group, 18 patients were enrolled. For all of the patients, SYNTAX score was 27.6±5.9 points, EUROscore integral average was 4.4±2.8 points and had no MACE occurred in hospitalization. During follow-up, the occurrence of cerebral infarction was one case, and had one of recurrent angina, but the coronary angiography showed bypass grafts was well and had no significant stenosis and further MACE events.After the clinical data of the two groups were compared, the basic conditions , biochemical, cardiac markers, were not significant statistical difference. However, LVEF values in the CABG group was higher than in the PCI group (51.16±13.31 VS 43.25±9.54, P=0.043, P<0.05), the difference was statistically significant; The patients of left main lesions combined three branchs in the CABG group more than PCI group (8.00% VS 38.89%, P=0.023, P<0.05), it was statistically significant. The reason was probably that the patients of the PCI group were assessed before selection. EUROscore points scores of patients in the two groups was not significant (3.5±2.9 VS 4.4±2.8, P=0.413, P>0.05). Although the high-risk patients by the SYNTAX score in the PCI group were less than in the CABG group (4.00% VS 33.33% P=0.015, P<0.05), the overall average score-line comparison (21.4±9.2 VS 27.6±5.9 P=0.467, P>0.05), the difference was not statistically significant. In the follow-up, the incidence of angina of the patients performed PCI were the same as CABG group, however, the symptom were not related with the target vessel after angiography. Both had no significant difference was founded in MACCE areas, too.Conclusion: For patients with unprotected left main disease, the PCI for low-risk and mid-risk patients made a choice after comprehensive assessment by the SYNTAX score and EUROscore points is safe and feasible, and can achieve satisfactory clinical efficacy, and was favorable compared to the CABG. However, for the high-risk patients, as a precautionary measure, the coronary artery bypass grafting should be recommended for the patient's life. For the patients were not willing to the coronary artery bypass surgery and insisted on undergoing the PCI, their requests could be accepted after the physician had full understanding of the basic clinical situation, such as LVEF of the patients was more than 40%.