【摘要】 目的比较经桡动脉途径(TRA)、经股动脉途径(TFA)行无保护左主干(ULMCA)病变经皮冠状动脉介入术(PCI)的安全性、可行性及临床疗效。方法纳入沈阳军区总医院2007年1月-2008年12月行ULMCA病变PCI的286例患者进行回顾性分析,其中,TRA 144例(TRA组),TFA 142例(TFA组)。比较两组冠状动脉造影(CAG)、手术操作成功率,复杂分叉病变支架置入术的应用,曝光时间,造影剂用量,局部血管并发症发生率,住院及随访期主要心脏不良事件(MACE)发生率,术后下床活动、术后住院及总住院时间的差异。结果两组患者基线资料特征相似。TRA组CAG、手术操作成功率(分别为96.5%、98.6%)与TFA组(分别为92.3%、97.9%)比较差异无统计学意义(P=0.116,P=0.641);TRA组复杂分叉病变支架置入术(Crush,Culotte,T stent)的应用(29.9%)、曝光时间(53.1±10.42min)、造影剂用量(247.66±106.98ml)与TFA组(分别为26.8%、51.23±9.80min、267.26±136.09ml)比较差异也无统计学意义(P=0.561、P=0.105、P=0.175)。TRA组局部血管并发症发生率(10.4%)明显低于TFA组(19.7%,P=0.028);TRA组住院期MACE率(6.3%)与TFA组(12.7%)比较差异无统计学意义(P=0.066);两组均无介入后心肌梗死(MI)、脑卒中、急诊冠状动脉旁路移植术(CABG);TRA组术后下床活动时间(1.37±0.62d)、术后住院时间(4.16±3.19d)、总住院时间(7.29±4.42d)均较TFA组(分别为2.40±1.45d、7.75±5.29d、12.10±7.58d)明显缩短(P<0.001);平均随访10±5.6个月,两组MACE率差异无统计学意义(10.1%vs 9.9%,P=0.953)。结论对ULMCA病变选择性支架置入术,TRA与TFA有相同疗效,且成功率相似,并发症发生率低,安全、可行。更多还原

【Abstract】 Objective To compare the safety,feasibility,and clinical efficacy of transradial approach(TRA) percutaneous coronary intervention(PCI) with transfemoral approach(TFA) PCI for unprotected left main coronary artery(ULMCA) disease.Methods The current study selected 286 patients who underwent PCI for ULMCA lesions in the General Hospital of Shenyang Military Region between Jan.2007 and Dec.2008,which included 144(TRA group) patients with TRA PCI and 142(TFA group) with TFA PCI for review analysis.Difference in coronary angiography(CAG),operation success rate,implantation of complex bifurcate lesion stent,X-ray exposure period,contrast agent dosage,local vascular complications,major adverse cardiac events(MACE) rate during hospitalization and visiting period,post-PCI ambulation,post-PCI hospitalization period,and the total hospitalization period between the two groups were compared.Results The two groups have similar baseline features.The difference between the TRA and TFA groups in CAG and operation success rate(96.5% and 98.6% for TRA and 92.3% and 97.9% for TFA,respectively) has no statistical significance(P=0.116,P=0.641).The difference between the TRA and TFA groups in terms of implantation rate(29.9% vs 26.8%) of complex bifurcate lesion stent(crushed,culotte,T stent),exposure period(53.1min±10.42min vs 51.23min±9.80min),and contrast agent dosage(247.66ml±106.98ml vs 267.26ml±136.09ml) has no statistical significance(P=0.561,P=0.105,P=0.175).The TRA group has lower local vascular complications(10.4% vs 19.7%) than the TFA group(P=0.028).MACE during hospitalization in the TRA group(6.3%) is lower than that in the TFA group(12.7%),but the difference has no statistical significance(P=0.066).Neither group has post-PCI myocardial infarction,stroke,or emergency coronary artery bypass grafting.The TRA group has shorter(P<0.001) post-PCI ambulation period(1.37days±0.62days vs 2.40days±1.45days),post-PCI hospitalization period(4.16days±3.19days vs 7.75days±5.29days) and total hospitalization period(7.29days±4.42days vs 12.10days±7.58days).During the visiting period of 10months±5.6months at average,the difference in MACE between the two groups(10.1% vs 9.9%,P=0.953) has no statistical significance.Conclusions The TRA approach has similar success rate and lower rate of complications than the TFA approach for the stent implantations for ULMCA.The TRA approach is safe and feasible and has the same effect as TFA.更多还原