左主支疾病：医学证据基础和现实世界.ppt

LuShuzhengM.D.FAPSIC.BeijingAnzhenHospitalCapitalMedicalUniversityLeftMainDisease:Evidence-baseMedicineRealisticWorld

AnatomyimportanceofLMCompromisesflowtoapproximately75%oftheleftventricle;AcuteocclusionofULMCAwillcauseMI,cardiacshockoracuteheartfailure,cardiacarrest(50%~70%).

AnatomyfeaturesofLMCADiseaseMostelastictissue;Higherelasticradialforce.

ClassificationbasedonlocationoflesionsOstiumShaft/BodyDistal

ClinicalResultsofDESforULMCA

DESfortheULMCAParketal.Chieffoetal.Valgimglietal.Leeetal.Priceetal.Migliorinietal.Erglisetal.Patients,n1028595505010153Distallesionlocation(%)71816560948781Cardiacmortality,6~12months(%)03ngiographicfollowup(%)84.3NRNR429896100Angiographicrestenosis(%)7*19?NRNR44?16*6*TLRorTVR(%)2§18.8║6.3║13║38§14║2§*Follow-upangiographyat6moths.?Fellow-upangiographyat4to8months.?Fellow-upangiographyat3and9months.§Targetlessinrevascularization.║Targetvesselrevascularization(TVR).DatefromBaimetal.DESdrugelutingstent;NRnotreported.

(3.7-7.7)RecentMeta-Analysisof1,278PatientsUndergoingUPLMDESFrom15RegistriesDatefromBiondi-ZoccaietalDESfortheULMCA)

RecentMeta-Analysisof1,278PatientsUndergoingUPLMDESFrom15RegistriesDatefromBiondi-ZoccaietalDESfortheULMCA(3.7-9.2)

PCIvs.CABGBolognaRegistry

PCIvs.CABGMilanexperience

PCIvs.CABGCedarsSinaiRegistry

LEMANSStudydesignNumberofpatientsscreenedwithULMCADisease:347Patientseligibleforstudy:122PatientsnoneligibleforstudyincludedinLEMANSRegistry:225Randomizedpatients:105Nonrandomizedpatients:17PCI102CABG123PCI52CABG53PCI9CABG8Allpatientstreatedaccordingtorandomization(nocrossover)FirstRCTstudyofULMCA

LEMANSStudybaselineVariablesPCI(n=52)CABG(n=53)PValueAge(yrs)60.6±10.561.3±8.40.69Male(%)60730.13CCSclass3.1±1.02.8±1