PDF(Pubmed)
Abstract：
Percutaneous coronary intervention (PCI) of the ostium of the left circumflex artery (LCx) is technically challenging. The aim of this study was to compare long-term clinical outcomes of ostial PCI located in the LCx versus the left anterior descending artery (LAD) in a propensity-matched population.
Consecutive patients with a symptomatic isolated \'de novo\' ostial lesion of the LCx or LAD treated with PCI were included. Patients with a stenosis of >40% in the left main (LM) were excluded. A propensity score matching was performed to compare both groups. The primary endpoint was target lesion revascularisation (TLR); other endpoints included target lesion failure and an analysis of the bifurcation angles.
From 2004 to 2018, 287 consecutive patients with LAD (n=240) or LCx (n=47) ostial lesions treated with PCI were analysed. After the adjustment, 47 matched pairs were obtained. The mean age was 72±12 years and 82% were male. The LM-LAD angle was significantly wider than the LM-LCx angle (128°±23° vs 108°±24°, p=0.002). At a median follow-up of 5.5 (IQR 1.5-9.3) years, the rate of TLR was significantly higher in the LCx group (15% vs 2%); with an HR of 7.5, 95% CI 2.1 to 26.4, p<0.001. Interestingly, in the LCx group, TLR-LM occurred in 43% of the TLR cases; meanwhile, no TLR-LM involvement was found in the LAD group.
Isolated ostial LCx PCI was associated with an increase in the rate of TLR compared with ostial LAD PCI at long-term follow-up. Larger studies evaluating the optimal percutaneous approach at this location are needed.
Consecutive patients with a symptomatic isolated \'de novo\' ostial lesion of the LCx or LAD treated with PCI were included. Patients with a stenosis of >40% in the left main (LM) were excluded. A propensity score matching was performed to compare both groups. The primary endpoint was target lesion revascularisation (TLR); other endpoints included target lesion failure and an analysis of the bifurcation angles.
From 2004 to 2018, 287 consecutive patients with LAD (n=240) or LCx (n=47) ostial lesions treated with PCI were analysed. After the adjustment, 47 matched pairs were obtained. The mean age was 72±12 years and 82% were male. The LM-LAD angle was significantly wider than the LM-LCx angle (128°±23° vs 108°±24°, p=0.002). At a median follow-up of 5.5 (IQR 1.5-9.3) years, the rate of TLR was significantly higher in the LCx group (15% vs 2%); with an HR of 7.5, 95% CI 2.1 to 26.4, p<0.001. Interestingly, in the LCx group, TLR-LM occurred in 43% of the TLR cases; meanwhile, no TLR-LM involvement was found in the LAD group.
Isolated ostial LCx PCI was associated with an increase in the rate of TLR compared with ostial LAD PCI at long-term follow-up. Larger studies evaluating the optimal percutaneous approach at this location are needed.
摘要：
背景：左旋支动脉口（LCx）的经皮冠状动脉介入治疗（PCI）在技术上具有挑战性。这项研究的目的是比较倾向匹配人群中位于LCx和左前降支动脉（LAD）的口PCI的长期临床结果。
方法：包括接受PCI治疗的有症状的孤立的LCx或LAD窦口病变的连续患者。排除左主干(LM)狭窄>40%的患者。进行倾向评分匹配以比较两组。主要终点是靶病变血运重建（TLR）；其他终点包括靶病变失败和分叉角度分析。
结果：从2004年到2018年，分析了287例接受PCI治疗的LAD（n=240）或LCx（n=47）口病变的连续患者。调整后,获得了47对配对。平均年龄72±12岁，82%为男性。LM-LAD角度明显比LM-LCx角度宽（128°±23°vs108°±24°，p=0.002)。在中位随访5.5年(IQR1.5-9.3年)时，LCx组的TLR率明显更高(15%比2%);HR为7.5,95%CI2.1~26.4,p<0.001。有趣的是,在LCx组中，TLR-LM发生在43%的TLR病例中；同时，LAD组未发现TLR-LM受累.
结论：在长期随访中，与开口LADPCI相比，孤立的开口LCxPCI与TLR的发生率增加相关。需要进行更大的研究来评估该位置的最佳经皮入路。
方法：包括接受PCI治疗的有症状的孤立的LCx或LAD窦口病变的连续患者。排除左主干(LM)狭窄>40%的患者。进行倾向评分匹配以比较两组。主要终点是靶病变血运重建（TLR）；其他终点包括靶病变失败和分叉角度分析。
结果：从2004年到2018年，分析了287例接受PCI治疗的LAD（n=240）或LCx（n=47）口病变的连续患者。调整后,获得了47对配对。平均年龄72±12岁，82%为男性。LM-LAD角度明显比LM-LCx角度宽（128°±23°vs108°±24°，p=0.002)。在中位随访5.5年(IQR1.5-9.3年)时，LCx组的TLR率明显更高(15%比2%);HR为7.5,95%CI2.1~26.4,p<0.001。有趣的是,在LCx组中，TLR-LM发生在43%的TLR病例中；同时，LAD组未发现TLR-LM受累.
结论：在长期随访中，与开口LADPCI相比，孤立的开口LCxPCI与TLR的发生率增加相关。需要进行更大的研究来评估该位置的最佳经皮入路。
