左主支疾病医学证据基础和现实世界（英文课件）.pptVIP

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. Clinical Results of DES for ULMCA DES for the ULMCA DES for the ULMCA DES for the ULMCA PCI vs. CABG Bologna Registry PCI vs. CABG Milan experience PCI vs. CABG Cedars Sinai Registry LE MANS Study design LE MANS Study baseline LE MANS Study LVEF at baseline and after 12 months LE MANS Study CCS function class at baseline and follow-up LE MANS Study treadmill stress tests at baseline and follow-up LE MANS Study ULMCA in Realistic World Left Main Strategies What do you think about this patient Male, 73y; Exertional Chest Pain 3m, Aggravated 10d; Diag: CAD UAP Braunwald ⅢB; 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. Final Result CABG vs. DES our experiences CABG vs. DES our experiences * * Lu Shuzheng M.D. FAPSIC. Beijing Anzhen Hospital Capital Medical University Left Main Disease: Evidence-base Medicine Realistic World Classification based on location of lesions Ostium Shaft/Body Distal 2 § 14 ║ 38 § 13 ║ 6.3 ║ 18.8 ║ 2 § TLR or TVR(%) 6 * 16 * 44 ? NR NR 19 ? 7 * Angiographic restenosis (%) 100 96 98 42 NR NR 84.3 Angiographic follow up(%) 2 11 2 4 11 3.5 0 Cardiac mortality,6~12 months(%) 81 87 94 60 65 81 71 Distal lesion location(%) 53 101 50 50 95 85 102 Patients, n Erglis et al. Migliorini et al. Price et al. Lee et al. Valgimgli et al. Chieffo et al. Park et al. *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