左主支疾病医学证据基础和现实世界（英文）课件

1、Lu Shuzheng M.D. FAPSIC.Beijing Anzhen HospitalCapital Medical UniversityLeft Main Disease: Evidence-base Medicine & Realistic World左主支疾病医学证据基础和现实世界（英文）1Anatomy importance of LMoCompromises flow to approximately 75% of the left ventricle;oAcute occlusion of ULMCA will cause MI ,cardiac shock or

2、acute heart failure, cardiac arrest(50%70%).左主支疾病医学证据基础和现实世界（英文）2Anatomy features of LMCA DiseaseoMost elastic tissue;oHigher elastic radial force.左主支疾病医学证据基础和现实世界（英文）3Classification based on location of lesionsOstium Shaft/Body Distal左主支疾病医学证据基础和现实世界（英文）4左主支疾病医学证据基础和现实世界（英文）5Clinical Results of DES

3、 for ULMCA左主支疾病医学证据基础和现实世界（英文）6DES for the ULMCAPark et al.Chieffo et al.Valgimgli et al.Lee et al.Price et al.Migliorini et al.Erglis et al.Patients, n1028595505010153Distal lesion location(%)71816560948781Cardiac mortality,612 months(%)03.51142112Angiographic follow up(%)84.3NRNR429896100Angiograp

4、hic restenosis (%)7 *19 NRNR44 16 *6 *TLR or TVR(%)2 18.8 6.3 13 38 14 2 *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 et al.DES drug eluting s

5、tent; NR not reported. 左主支疾病医学证据基础和现实世界（英文）7(3.7-7.7)Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 RegistriesDate from Biondi-Zoccai et alDES for the ULMCA(3.4-7.7)左主支疾病医学证据基础和现实世界（英文）8Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 RegistriesDate from Biondi-

6、Zoccai et alDES for the ULMCA(3.7-9.2)左主支疾病医学证据基础和现实世界（英文）9PCI vs. CABG Bologna Registry左主支疾病医学证据基础和现实世界（英文）10PCI vs. CABG Milan experience左主支疾病医学证据基础和现实世界（英文）11PCI vs. CABG Cedars Sinai Registry左主支疾病医学证据基础和现实世界（英文）12LE MANS Study designNumber of patients screened with ULMCA Disease:347Patients elig

7、ible 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 ULMCA左主支疾病医学证据基础和现实世界（英文）13LE MANS Study baselineVariable

8、sPCI(n=52)CABG(n=53)P ValueAge (yrs)60.610.561.38.40.69Male (%)60730.13CCS class3.11.02.81.00.17LVEF (%)21170.58Distal LM disease (%)56600.63No. of diseased vessels1.730.932.08 0.830.33DES/arterial graft to LAD (%) 3581-Complete revascularization (%)79890.17Hospitalization (days)6.8 3.712.04 9.60.00

9、07左主支疾病医学证据基础和现实世界（英文）14LE MANS Study LVEF at baseline and after 12 monthsp=0.22p=0.04p=0.01p=0.85左主支疾病医学证据基础和现实世界（英文）15LE MANS Study CCS function class at baseline and follow-upp=0.22p=0.01p=0.10p=0.01p=0.11左主支疾病医学证据基础和现实世界（英文）16LE MANS Study treadmill stress tests at baseline and follow-upp=0.03p=

10、0.31p=0.97p=0.53左主支疾病医学证据基础和现实世界（英文）17LE MANS StudyPCICABGSurvival after PCI and CABGMACCE-Free Survival after PCI and CABGPCICABG左主支疾病医学证据基础和现实世界（英文）18More RCT Trial Needed左主支疾病医学证据基础和现实世界（英文）19ULMCA in Realistic World左主支疾病医学证据基础和现实世界（英文）20Left Main StrategiesOstium LesionsShaft LesionsBifurcation

11、Lesions左主支疾病医学证据基础和现实世界（英文）21What do you think about this patientoMale, 73y;oExertional Chest Pain 3m, Aggravated 10d;oDiag: CAD UAP Braunwald B;oOther RF: HT, Smoking;oEcho: EF 68%, LVEDD 50mm;oTo Cath Lab.左主支疾病医学证据基础和现实世界（英文）224 Bifurcation Lesions oWhich one is the first;oTechnique of each lesion

12、; oV/T/Kissing stent for LM;oHow to do the final kissing.CrossoverT StentT StentCrush左主支疾病医学证据基础和现实世界（英文）23GC: 7F JL4; GW: Stablizer Supersoft, Runthrough, Rinato, ATW; BC: Sprinter 2.5*15mm, Sprinter 1.5*15mm;SC: SES 3.0*24mm, SES 2.5*33mm左主支疾病医学证据基础和现实世界（英文）24SC: SES 2.5*18mm, SES 3.5*18mm左主支疾病医学证

13、据基础和现实世界（英文）25GW: Pilot50; BC: Sequent 3.0*10mm SC: SES 4.0*15mm左主支疾病医学证据基础和现实世界（英文）26Final Result左主支疾病医学证据基础和现实世界（英文）27CABG 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 Lesions左主支疾病医学证据基础和现实世界（英文）28CABG vs. DES our experiencesp0.0