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1、Lu Shuzheng M.D. FAPSIC.Beijing Anzhen HospitalCapital Medical UniversityLeft Main Disease: Evidence-base Medicine oAcute occlusion of ULMCA will cause MI ,cardiac shock or acute heart failure, cardiac arrest(50%70%).Anatomy features of LMCA DiseaseoMost elastic tissue;oHigher elastic radial force.C
2、lassification based on location of lesionsOstium Shaft/Body DistalClinical Results of DES for ULMCADES 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 mon
3、ths(%)03.51142112Angiographic follow up(%)84.3NRNR429896100Angiographic 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 ves
4、sel 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-Zoccai et alDES for the ULMCA(3.4-7.7)Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 R
5、egistriesDate 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 screened with ULMCA Disease: 347Patients eligible for study: 122Patients noneligible for study included i
6、n LE MANS Registry: 225Randomized patients: 105Nonrandomized patients: 17PCI 102CABG 123PCI 52CABG 53PCI 9CABG 8All patients treated according to randomization (no crossover)First RCT study of ULMCALE MANS Study baselineVariablesPCI (n=52)CABG (n=53)P ValueAge (yrs)60.610.561.38.40.69Male (%)60730.1
7、3CCS 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 9.60.0007LE MANS Study LVEF at baseline and after 12 monthsp=0.22p=0.04p=0.01
8、p=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 StudyPCICABGSurvival after PCI and CABGMACCE-Free Survival after PCI and CABGPCICABGMore RCT Trial NeededULMCA i
9、n 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 RF: HT, Smoking;oEcho: EF 68%, LVEDD 50mm;oTo Cath Lab.4 Bifurcation Lesions oWhich one is the
10、 first;oTechnique of each lesion; oV/T/Kissing stent for LM;oHow to do the final kissing.CrossoverT StentT StentCrushGC: 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*33mmSC: SES 2.5*18mm, SES 3.5*18mmGW: Pilot50; BC: Se
11、quent 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 -FU 4yFrom 2004 to 2006, 393 pts with LM lesions, FU 4y, Registry Study255 pts in CABG Group & 138 pts in DES GroupSurvival -FU 4yp0.0580%Thanks
