Background： Very few data have been reported for ST-segment elevation myocardial infarction （STEMI） caused by unprotected left main coronary artery （ULMCA） occlusion, and very little is known about the results of...Background： Very few data have been reported for ST-segment elevation myocardial infarction （STEMI） caused by unprotected left main coronary artery （ULMCA） occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention （PCI）. The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. Methods： From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion （ULMCA-STEMI） who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI （NSTEMI） caused by ULMCA lesion （U LMCA-NSTEMI） who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events （MACEs） in-hospital, at 1 month, and at 1 year. Results： Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥Ⅲ （21.2% vs. 3.5%,χ^2= 36.253, P 〈 0.001 ） and cardiac arrest （8.3% vs. 3.5%, χ^2= 5.529, P = 0.019）. For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction （TIMI） flow grade〈3 were significantly higher than those in the patients with a TIMI flow grade of 3 （STEMI group： 51.7% [ 15/29] vs. 4.1% [ 14/343], P 〈 0.001 ; NSTEM I group： 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEM I group were associated with higher risks of MACE （16.7% vs. 9.1%, P 0.009） and cardiac death （5.4% vs. 1.3%, P- 0.011 ） compared with NSTEMI patients at I month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI （all P=0.72） in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in rei展开更多
Background The long term prognosis of unprotected left main coronary artery （LMCA） stenting is controversial This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese pati...Background The long term prognosis of unprotected left main coronary artery （LMCA） stenting is controversial This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes. Methods From May 1997 to March 2003, 224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis. Results Stents were implanted into LMCA successfully in 223 cases （99.6 %）. One death （0.5%） and one case of non-Q wave nonfatal myocardial infarction （MI） occurred in hospital. The mean follow-up time was （15.6±12.3） months. Cardiac death developed in 10 cases （4.5%）, noncardiac death in 2 cases （0.9%）, nonfatal MI in 4 cases （1.8%）, target lesion revascularization （TLR） of LMCA in 26 cases （11.7%） and TLR of nonLMCA in 37 cases （16.5%）. Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction （LVEF 〈 40%）, female gender and LMCA combined with multivessel disease; that major adverse cardiac events （MACE） correlated with LVEF 〈 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF 〈 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases （45.7%）. The restenosis rate was 31.4%. Conclusions Long-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF ≥40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained.展开更多
Background Angioplasty in the unprotected left main coronary artery （LMCA） has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug e...Background Angioplasty in the unprotected left main coronary artery （LMCA） has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent （DES）, for treatment of unprotected LMCA disease. Methods Between September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention （PCI） on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES ＂＇era＂ （group I, from September 1997 to December 2002） were compared with those in DES ＂era＂ （group Ⅱ, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group）. Results Altogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft （CABG） successfully. Bifurcation techniques for distal LMCA executed in 206 patients （69.4%, 2061297）, included crossover stenting in 156 （75.7%）, T stenting in 4 （1.9%）, provisional T stenting in 28 （13.6%）, kissing stenting in 5 （2.4%） and stent crushing in 13 （6.3%） patients. During their hospital stay, 5 （1.7%） patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events （MACE） were 2.0% （6/297）. In the follow-up period, 19 patients （6.5%） died [15 （5.1%） of cardiac death and 4 of non-fatal myocardial infarction （MI）]. Besides, 2 （0.7%） developed subacute thrombosis （SAT） and 16 （5.4%） performed target lesion revascularization （TLR）. The total follow-up MACE was 14.5% （431297）. Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement （14.7% vs 81.9%, P〈0.001）, and more bifurcation lesions �展开更多
Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with ...Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specific展开更多
文摘Background： Very few data have been reported for ST-segment elevation myocardial infarction （STEMI） caused by unprotected left main coronary artery （ULMCA） occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention （PCI）. The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. Methods： From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion （ULMCA-STEMI） who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI （NSTEMI） caused by ULMCA lesion （U LMCA-NSTEMI） who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events （MACEs） in-hospital, at 1 month, and at 1 year. Results： Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥Ⅲ （21.2% vs. 3.5%,χ^2= 36.253, P 〈 0.001 ） and cardiac arrest （8.3% vs. 3.5%, χ^2= 5.529, P = 0.019）. For both groups, the proportions of one-year cardiac death in the patients with a post-procedure thrombolysis in myocardial infarction （TIMI） flow grade〈3 were significantly higher than those in the patients with a TIMI flow grade of 3 （STEMI group： 51.7% [ 15/29] vs. 4.1% [ 14/343], P 〈 0.001 ; NSTEM I group： 33.3% [3/9] vs. 13.6% [3/221], P = 0.001; respectively]. Landmark analysis showed that the patients in STEM I group were associated with higher risks of MACE （16.7% vs. 9.1%, P 0.009） and cardiac death （5.4% vs. 1.3%, P- 0.011 ） compared with NSTEMI patients at I month. Meanwhile, in patients with ULMCA, the landmark analysis for incidences of MACE and cardiac death was similar between the STEMI and NSTEMI （all P=0.72） in the intervals of 1-12 months. However, patients who were diagnosed with STEMI or NSTEMI had no significant difference in rei
文摘Background The long term prognosis of unprotected left main coronary artery （LMCA） stenting is controversial This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes. Methods From May 1997 to March 2003, 224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis. Results Stents were implanted into LMCA successfully in 223 cases （99.6 %）. One death （0.5%） and one case of non-Q wave nonfatal myocardial infarction （MI） occurred in hospital. The mean follow-up time was （15.6±12.3） months. Cardiac death developed in 10 cases （4.5%）, noncardiac death in 2 cases （0.9%）, nonfatal MI in 4 cases （1.8%）, target lesion revascularization （TLR） of LMCA in 26 cases （11.7%） and TLR of nonLMCA in 37 cases （16.5%）. Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction （LVEF 〈 40%）, female gender and LMCA combined with multivessel disease; that major adverse cardiac events （MACE） correlated with LVEF 〈 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF 〈 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases （45.7%）. The restenosis rate was 31.4%. Conclusions Long-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF ≥40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained.
文摘Background Angioplasty in the unprotected left main coronary artery （LMCA） has been controversial. This study aims to evaluate the safety and clinical effectiveness of stenting, including bare metal stent and drug eluting stent （DES）, for treatment of unprotected LMCA disease. Methods Between September 1997 and December 2005, a total of 297 consecutive patients underwent percutanous coronary intervention （PCI） on LMCA lesions in our hospital. Their in-hospital data and clinical follow-up outcomes were analyzed and those in pre-DES ＂＇era＂ （group I, from September 1997 to December 2002） were compared with those in DES ＂era＂ （group Ⅱ, from January 2003 to December 2004. Patients in 2005 for the time of follow-up less than one year were not included in this group）. Results Altogether 368 coronary stents were successfully deployed in 295 patients. Stents failed to be implanted after balloon predilation in two patients, who received coronary artery bypass graft （CABG） successfully. Bifurcation techniques for distal LMCA executed in 206 patients （69.4%, 2061297）, included crossover stenting in 156 （75.7%）, T stenting in 4 （1.9%）, provisional T stenting in 28 （13.6%）, kissing stenting in 5 （2.4%） and stent crushing in 13 （6.3%） patients. During their hospital stay, 5 （1.7%） patients died after PCI procedure, of which 4 died from cardiac origin and one of renal failure. The total in-hospital major adverse cardiac events （MACE） were 2.0% （6/297）. In the follow-up period, 19 patients （6.5%） died [15 （5.1%） of cardiac death and 4 of non-fatal myocardial infarction （MI）]. Besides, 2 （0.7%） developed subacute thrombosis （SAT） and 16 （5.4%） performed target lesion revascularization （TLR）. The total follow-up MACE was 14.5% （431297）. Further analysis also showed that, compared with patients in group I, those in group II apparently had more multi-vessel involvement （14.7% vs 81.9%, P〈0.001）, and more bifurcation lesions �
文摘Background There are few reports of quantitative and qualitative measuring of left main coronary artery （LMCA） plaques by multislice computed tomography coronary angiography （MSCTA）, especially when compared with intravascular ultrasound （IVUS） as reference standard. The aim of this study was to evaluate the use of 64-MSCTA in the diagnosis of LMCA disease, and the accuracy of MSCTA in the quantitative and qualitative assessment of the LMCA lesion as compared with IVUS.Methods A total of 91 patients （53 men, 38 women, mean age （64.78±9.19） years） were examined by 64-MSCTA and IVUS. Compared with the IVUS, the sensitivity, specificity, positive and negative predictive values （PPV and NPV） of the MSCTA on the diagnosis of LMCA diseases were calculated. Also, kappa index （K） for the agreement between MSCTA and IVUS was calculated. Minimal lumen area （MLA）, external elastic membrane cross-sectional area （EEM-CSA） and plaque burden were measured by two blinded and independent operators on MSCTA cross-sectional reconstruction and compared with the parameters measured from IVUS by manually tracing. The CT value of soft, fibrous and calcific plaques was measured using IVUS classification of the plaques.Results The sensitivity, specificity, PPV and NPV of MSCTA for detecting LMCA plaques were 93.1%, 84.2%, 95.7%, 76.2%, respectively. Kappa index （K=0.744, P〈0.001） indicated excellent agreement between MSCTA and IVUS. The Pearson index between MLA on IVUS and MLA on MSCTA was 0.815 （P 〈0.01）. The Pearson index of plaque burden and EEM-CSA between IVUS and MSCTA was 0.736 and 0.740 respectively （both P 〈0.01）. The CT value of soft plaque, fibrous plaque and calcific plaque compared with IVUS were （52.52±15.71） HU, （108.32±43.44） HU and （604.16±377.67） HU （P〈0.001）. Receiver operating characteristic curve analysis of CT value of non-calcific plaques for predicting soft plaques showed the cutpoint was 54.35 HU, with a sensitivity of 83.3% and specific
