左主支疾病：医学证据基础和现实世界PPT.pptVIP

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 (3.7-7.7) Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Registries Date from Biondi-Zoccai et al DES for the ULMCA (3.4-7.7) Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Registries Date from Biondi-Zoccai et al DES for the ULMCA (3.7-9.2) 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) 60.6±10.5 61.3±8.4 0.69 Male (%) 60 73 0.13 CCS class 3.1±1.0 2.8±1.0 0.17 LVEF (%) 21 17 0.58 Distal LM disease (%) 56 60 0.63 No. of diseased vessels 1.73±0.93 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