左主支疾病：医证据基础和现实世界英文课件VIP

1、lu shuzheng m.d. fapsic.beijing anzhen hospitalcapital medical universityleft main disease: evidence-base medicine & realistic worldanatomy importance of lmocompromises flow to approximately 75% of the left ventricle;oacute occlusion of ulmca will cause mi ,cardiac shock or acute heart failure,

2、cardiac arrest(50%70%).anatomy features of lmca diseaseomost elastic tissue;ohigher elastic radial force.classification based on location of lesionsostium shaft/body distalclinical results of des for ulmcades for the ulmcapatients, ndistal lesion location(%)cardiac mortality,612 months(%)angiographi

3、c follow up(%)angiographic restenosis (%)tlr or tvr(%)park et al.10271084.37 *2 chieffo et al.85813.5nr19 18.8 valgimgli et al.956511nrnr6.3 lee et al.5060442nr13 price et al.509429844 38 migliorini et al.10187119616 *14 erglis et al.538121006 *2 *follow-up angiography at 6 moths. fellow-up angiogra

4、phy 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. (3.7-7.7)recent meta-analysis of 1,278 patients undergoing uplm des from 15 registriesdate from biondi-

5、zoccai et aldes for the ulmca(3.4-7.7)recent meta-analysis of 1,278 patients undergoing uplm des from 15 registriesdate from biondi-zoccai et aldes for the ulmca(3.7-9.2)pci vs. cabg bologna registrypci vs. cabg milan experiencepci vs. cabg cedars sinai registryle mans study designnumber of patients

6、 screened with ulmca disease:347patients eligible for study:122patients noneligible for study included in le mans registry:225randomized patients:105nonrandomized patients:17pci102cabg123pci52cabg53pci9cabg8all patients treated according to randomization (no crossover)first rct study of ulmcale mans

7、 study baselinevariablesage (yrs)male (%)ccs classlvef (%)distal lm disease (%)no. of diseased vesselsdes/arterial graft to lad (%) complete revascularization (%)hospitalization (days)pci(n=52)60.610.5603.11.021561.730.9335796.8 3.7cabg(n=53)61.38.4732.81.017602.08 0.83818912.04 9.6p value0.690.130.

8、170.580.630.33-0.170.0007le mans study lvef at baseline and after 12 monthsp=0.22p=0.04p=0.01p=0.85le mans study ccs function class at baseline and follow-upp=0.22p=0.01p=0.10p=0.01p=0.11le mans study treadmill stress tests at baseline and follow-upp=0.03p=0.31p=0.97p=0.53le mans studypcicabgsurviva

9、l after pci and cabgmacce-free survival after pci and cabgpcicabgmore rct trial neededulmca in realistic worldleft main strategiesostium lesionsshaft lesionsbifurcation lesionswhat do you think about this patientomale, 73y;oexertional chest pain 3m, aggravated 10d;odiag: cad uap braunwald b;oother r

10、f: ht, smoking;oecho: ef 68%, lvedd 50mm;oto cath lab.4 bifurcation lesions o which one is the first;o technique of each lesion; o v/t/kissing stent for lm;o how to do the final kissing.crossovert stentt stentcrushgc: 7f jl4; gw: stablizer supersoft, runthrough, rinato, atw; bc: sprinter 2.5*15mm, s

11、printer 1.5*15mm;sc: ses 3.0*24mm, ses 2.5*33mmsc: ses 2.5*18mm, ses 3.5*18mmgw: pilot50; bc: sequent 3.0*10mm sc: ses 4.0*15mmfinal resultcabg vs. des our experienceslesions distributionfrom 2004 to 2006, 393 pts with lm lesions, fu 4y, registry study255 pts in cabg group & 138 pts in des groupdifferent techniques of bifurcation lesionscabg vs. des our experiencesp0.05prognosis