无保护左主干疾病经皮冠状动脉介入治疗中额外血管的治疗：来自大型前瞻性登记的见解。

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-02-18 DOI:10.1016/j.amjcard.2025.02.014

Sean Gilhooley MD, David Power MD, Anastasios Roumeliotis MD, Richard Tanner MD, Anton Camaj MD, Samantha Sartori PhD, Kenneth Smith MPH, Johny Nicolas MD, Rakhee R. Makhija MD, Pier Pasquale Leone MD, Keisuke Yasumura MD, Manish Vinayak MD, Amit Hooda MD, Parasuram Melarcode Krishnamoorthy MD, Serdar Farhan MD, Joseph Michael Sweeny MD, George D. Dangas MD, PhD, Roxana Mehran MD, Annapoorna S. Kini MD, Samin K. Sharma MD

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引用次数: 0

摘要

经皮冠状动脉介入治疗（PCI）是冠状动脉旁路移植术的替代方案，用于治疗无保护的左主干（LM）冠状动脉疾病（CAD）患者。本研究评估了在LM-PCI期间治疗额外冠状动脉的安全性和临床影响。2010年至2021年在美国纽约西奈山医院连续接受PCI药物洗脱支架治疗无保护LM-CAD的患者符合纳入条件。根据患者是否单独接受了LM复合体的治疗，还是同时接受了LM复合体外的额外血管的PCI治疗，对患者进行了分层。主要终点是PCI术后1年的主要不良心血管事件（MACE），即死亡、心肌梗死或卒中的复合指标。在869例连续接受LM-PCI的患者（平均年龄70.9岁，33.0%为女性，平均SYNTAX评分27.9）中，479例（55.1%）患者单独接受了LM复体治疗，390例（44.9%）患者同时接受了另一条非LM血管的PCI治疗。与单纯LM并发症PCI相比，1年MACE发生率无显著差异[HR 12.0% vs. 13.3%；人力资源:0.95;95% CI (0.62 - 1.44), p = 0.797]，甚至在调整潜在混杂因素后[HR 12.0% vs. 13.3%；人力资源:0.87;95% CI (0.56 - 1.36), p = 0.550]。总之，在接受无保护LM-PCI的大型现实队列患者中，与单独LM复合PCI相比，额外治疗非LM血管并未增加1年MACE的风险。

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Treatment of Additional Vessels During Percutaneous Coronary Intervention for Unprotected Left Main Disease: Insights From a Large Prospective Registry

Percutaneous coronary intervention (PCI) is an established alternative to coronary artery bypass grafting for the treatment of select patients with unprotected left main (LM) coronary artery disease (CAD). This study evaluates the safety and clinical impact of treating additional coronary arteries during LM-PCI. Consecutive patients undergoing PCI with drug-eluting stents for unprotected LM-CAD between 2010 and 2021 at The Mount Sinai Hospital, New York, USA were eligible for inclusion. Patients were stratified based on whether they underwent treatment of the LM complex alone or had concomitant PCI to an additional vessel outside the LM complex. The primary outcome was major adverse cardiovascular events (MACE), a composite of death, myocardial infarction, or stroke, at 1 year following PCI. Among 869 consecutive patients (mean age 70.9, 33.0% female, 27.9 mean SYNTAX score) undergoing LM-PCI, 479 (55.1%) underwent treatment of the LM complex alone, and 390 (44.9%) had concomitant PCI of an additional non-LM vessel. Compared with LM complex PCI only, there were no significant differences in the rate of MACE at 1 year [HR 12.0% vs 13.3%; HR: 0.95; 95% CI (0.62–1.44), p = 0.797], even after adjustment for potential confounders [HR 12.0% vs 13.3%; HR: 0.87; 95% CI (0.56–1.36), p = 0.550]. In conclusion, in a large, real-world cohort of patients undergoing unprotected LM-PCI, treatment of an additional non-LM vessel did not increase the risk of MACE at 1 year compared to LM complex PCI alone.

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.