左主支疾病：医学证据基础和现实世界(英文).ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Lu Shuzheng M.D.FAPSIC.,Beijing Anzhen Hospital,Capital Medical University,Left Main Disease:,Evidence-base Medicine&Realistic World,Anatomy,importance of LM,Compromises flow to approximately 75%of the left ventricle;,Acute occlusion of ULMCA will cause MI,cardiac shock or acute heart failure,cardiac arrest(50%70%).,Anatomy features of LMCA Disease,Most elastic tissue;,Higher elastic radial force.,Classification,based on location of lesions,Ostium Shaft/Body Distal,Clinical Results of DES for ULMCA,DES for the ULMCA,Park et al.,Chieffo et al.,Valgimgli et al.,Lee et al.,Price et al.,Migliorini et al.,Erglis et al.,Patients,n,102,85,95,50,50,101,53,Distal lesion location(%),71,81,65,60,94,87,81,Cardiac mortality,612 months(%),0,3.5,11,4,2,11,2,Angiographic follow up(%),84.3,NR,NR,42,98,96,100,Angiographic restenosis(%),7,*,19,NR,NR,44,16,*,6,*,TLR or TVR(%),2,18.8,6.3,13,38,14,2,*,Follow-up angiography at 6 moths.,Fellow-up angiography at 4 to 8 months.Fellow-up angiography at 3 and 9 months.Target lessin revascularization.Target vessel revascularization(TVR).Date from Baim et al.,DES drug eluting stent;NR not reported.,PCI vs.CABG,Bologna Registry,PCI vs.CABG,Milan experience,PCI vs.CABG,Cedars Sinai Registry,LE MANS Study,design,Number of patients screened with ULMCA Disease:,347,Patients eligible for study:,122,Patients noneligible for study,included in LE MANS Registry:,225,Randomized patients:,105,Nonrandomized patients:,17,PCI,102,CABG,123,PCI,52,CABG,53,PCI,9,CABG,8,All patients treated according to randomization(no crossover),First RCT study of ULMCA,LE MANS Study,baseline,Variables,PCI,(n=52),CABG,(n=53),P Value,Age(yrs),60.610.5,61.38.4,0.69,Male(%),60,73,0.13,CCS class,3.11.0,2.81.0,0.17,LVEF(%),21,17,0.58,Distal LM disease(%),56,60,0.63,No.of diseased vessels,1.730.93,2.08 0.83,0.33,DES/arterial graft to LAD(%),35,81,-,Complete revascularization(%),79,89,0.17,Hospitalization(days),6.8 3.7,12.04 9.6,0.0007,LE MANS Study,LVEF at baseline and after 12 months,p=0.22,p=0.04,p=0.01,p=0.85,LE MANS Study,CCS function class at baseline and follow-up,p=0.22,p=0.01,p=0.10,p=0.01,p=0.11,LE MANS Study,treadmill stress tests,at baseline and follow-up,p=0.03,p=0.31,p=0.97,p=0.53,LE MANS Study,PCI,CABG,Survival after PCI and CABG,MACCE-Free Survival after PCI and CABG,PCI,CABG,More RCT Trial Needed,ULMCA in Realistic World,Left Main Strategies,Ostium Lesions,Shaft Lesions,Bifurcation Lesions,What do you think about this patient,Male,73y;,Exertional Chest Pain 3m,Aggravated 10d;,Diag:CAD UAP Braunwald B;,Other RF:HT,Smoking;,Echo:EF 68%,LVEDD 50mm;,To Cath Lab.,4 Bifurcation Lesions,Which one is the first;,Technique of each lesion;,V/T/Kissing stent for LM;,How to do the final kissing.,Crossover,T Stent,T Stent,Crush,GC:7F JL4;GW:Stablizer Supersoft,Runthrough,Rinato,ATW;BC:Sprinter 2.5*15mm,Sprinter 1.5*15mm;,SC:SES 3.0*24mm,SES 2.5*33mm,SC:SES 2.5*18mm,SES 3.5*18mm,GW:Pilot50;BC:Sequent 3.0*10mm SC:SES 4.0*15mm,Final Result,CABG vs.DES,our experiences,Lesions Distribution,From 2004 to 2006,393 pts with LM lesions,FU 4y,Registry Study,255 pts in CABG Group&138 pts in DES Group,Different Techniques of Bifurcation Lesions,CABG vs.DES,our experiences,p,0.05,Prognosis-FU 4y,From 2004 to 2006,393 pts with LM lesions,FU 4y,Registry Study,255 pts in CABG Group&138 pts in DES Group,Survival-FU 4y,p,0.05,80%,Thanks,