左主支疾病：医学证据基础和现实世界（英文课件）

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1、LuShuzhengM.D.FAPSIC.BeijingAnzhenHospitalCapitalMedicalUniversityLeftMainDisease:Evidence-baseMedicine&RealisticWorldAnatomyimportanceofLMCompromisesflowtoapproximately75%oftheleftventricle;AcuteocclusionofULMCAwillcauseMI,cardiacshockoracuteheartfailure,cardiacarrest(50%~70%).Anato

2、myfeaturesofLMCADiseaseMostelastictissue;Higherelasticradialforce.ClassificationbasedonlocationoflesionsOstiumShaft/BodyDistalClinicalResultsofDESforULMCADESfortheULMCAParketal.Chieffoetal.Valgimglietal.Leeetal.Priceetal.Migliorinietal.Erglisetal.Patients,n1028595505010153Distallesio

3、nlocation(%)71816560948781Cardiacmortality,6~12months(%)03.51142112Angiographicfollowup(%)84.3NRNR429896100Angiographicrestenosis(%)7*19†NRNR44‡16*6*TLRorTVR(%)2§18.8║6.3║13║38§14║2§*Follow-upangiographyat6moths.†Fellow-upangiographyat4to8months.‡Fellow-upangiographyat3and9months.§Ta

4、rgetlessinrevascularization.║Targetvesselrevascularization(TVR).DatefromBaimetal.DESdrugelutingstent;NRnotreported.(3.7-7.7)RecentMeta-Analysisof1,278PatientsUndergoingUPLMDESFrom15RegistriesDatefromBiondi-ZoccaietalDESfortheULMCA(3.4-7.7)RecentMeta-Analysisof1,278PatientsUndergoingU

5、PLMDESFrom15RegistriesDatefromBiondi-ZoccaietalDESfortheULMCA(3.7-9.2)PCIvs.CABGBolognaRegistryPCIvs.CABGMilanexperiencePCIvs.CABGCedarsSinaiRegistryLEMANSStudydesignNumberofpatientsscreenedwithULMCADisease:347Patientseligibleforstudy:122PatientsnoneligibleforstudyincludedinLEMANSReg

6、istry:225Randomizedpatients:105Nonrandomizedpatients:17PCI102CABG123PCI52CABG53PCI9CABG8Allpatientstreatedaccordingtorandomization(nocrossover)FirstRCTstudyofULMCALEMANSStudybaselineVariablesPCI(n=52)CABG(n=53)PValueAge(yrs)60.6±10.561.3±8.40.69Male(%)60730.13CCSclass3.1±1.02.8±1.00.

7、17LVEF(%)21170.58DistalLMdisease(%)56600.63No.ofdiseasedvessels1.73±0.932.08±0.830.33DES/arterialgrafttoLAD(%)3581---Completerevascularization(%)79890.17Hospitalization(days)6.8±3.712.04±9.60.0007LEMANSStudyLVEFatbaselineandafter12monthsp=0.22p=0.04p=0.01p=0.85LEMANSStudyCCSfunctionc

8、lassatbaseli