| Objective:To explore the clinical characteristics of left main coronary artery stenosis and compare the curative effect of two treatments, including percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).Methods:From May2007to October2011,a total of154patients with left main coronary artery stenosis was collected in Tianjin Thoracic Hospital.According to the different treatment methods,these patients are divided into two groups:(1)90cases in PCI group, undergoing percutaneous coronary intervention in the internal medicine-cardiovascular Department;(2)64cases in CABG group,undergoing coronary artery bypass grafting in the cardiac surgery.We compared the clinical data,coronary angiography results and treatment options of two groups. All of patients were followed up for at least6months.By comparison of EUROscore, Parsonnet score and SYNTAX score between the two groups, we observed its prognosis effect, analyzed all-cause mortality, target lesion revascularization, nonfatal myocardial infarction, major adverse cardiac events, major adverse cardiac and cerebral events, angina of two groups,and evaluated the curative effect of two treatment methods.Results:1. Comparison of the clinical data:There was no statistically significant difference in the gender, age, time of angina pectoris and other basic clinical data in the two group patients (P>0.05).LVEF (%) in PCI group was significantly higher than that in CABG group(57.41±8.31vs51.25±8.54, P=0.000).The following-up time (months) between the two groups has no statistical significance, PCI and CABG group (16.9±8.7vs16.4±7.9, P=0.684).About the EUROscore, Parsonnet score and SYNTAX score, there was no statistically significant difference between the two groups (P>0.05).The incidence rate of MACCE in the PCI group was positively correlated with the above points.2. Outcomes of CAG:The left main bifurcation lesions level was Ⅲ lesions, there were15(16.7%) patients in the PCI group and32(50.0%) patients in the CABG group (P=0.000).Results of PCI:The specifications of stenting was (3.7±0.6×20.0±5.0)mm.The drug-eluting stents (DES) application accounted for95.0%. The success rate of left main coronary artery stents implantation and coronary artery stents implantation were both100%. There were6(6.7%) patients were accepted the intra-aortic balloon counterpulsation (IABP) and5(5.5%) patients accepted intravascular ultrasound (IVUS) examination in the PCI group.3. Follow-up results:Not only the incidence of MACE in the PCI group was higher than that in the CABG group (26.7%vs14.1%, P=0.060),but the incidence of MACCE in the PCI group was higher than that in the CABG group (30.0%vs17.2%, P=0.069). The differences of two groups had no statistical significance. Reascularization rates in the PCI group were higher than that in the CABG group (17.8%vs6.3%, P=0.036), the difference had statistical significance.Compared with non-ACS subunit, ACS subunit was higher in the incidence of MACE (39.2%vs10.2%, P=0.002) in the PCI group.Target lesion revascularization rates in the diabetic patients were significantly higher than that in the non-diabetic patients (31.3%vs10.3%, P=0.013) in the PCI group. No MACE survival curve of two groups was similar (log-rank test,P=0.096). Cox repression models showed Diabetes was an independent predictive factor of influencing the incidence of MACE.Conclusion:1. The short-term efficacy of the patients with left main coronary artery disease underwent PCI or CABG was same.2. Compared with CABG, the long-term curative effect of PCI for the selected patients with left main coronary artery stenosis was similar.3. The patients with acute coronary syndrome were higher risk on the incidence of MACE after PCI. Target lesion revascularization rates in the diabetic patients were significantly higher than that in the non-diabetic patients.4. Diabetes was an independent predictive factor of influencing the incidence of MACE after left main coronary artery lesion revascularization. |
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