左主支疾病医学证据基础和现实世界（英文课件）

Lu Shuzheng M.D. FAPSIC. Beijing Anzhen Hospital Capital Medical University,Left Main Disease:,Evidence-base Medicine & Realistic World,Anatomy importance of LM,Compromises flow to approximately 75% of the left ventricle; Acute occlusion of ULMCA will cause MI ,cardiac shock or acute heart failure, cardiac arrest(50%70%).,Anatomy features of LMCA Disease,Most elastic tissue; Higher elastic radial force.,Classification based on location of lesions,Ostium Shaft/Body Distal,Clinical Results of DES for ULMCA,DES for the ULMCA,*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 stent; NR not reported.,(3.7-7.7),Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Registries Date from Biondi-Zoccai et al,DES for the ULMCA,(3.4-7.7),Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Registries Date from Biondi-Zoccai et al,DES for the ULMCA,(3.7-9.2),PCI vs. CABG Bologna Registry,PCI vs. CABG Milan experience,PCI vs. CABG Cedars Sinai Registry,LE MANS Study design,Number of patients screened with ULMCA Disease: 347,Patients eligible for study: 122,Patients noneligible for study included in LE MANS Registry: 225,Randomized patients: 105,Nonrandomized patients: 17,PCI 102,CABG 123,PCI 52,CABG 53,PCI 9,CABG 8,All patients treated according to randomization (no crossover),First RCT study of ULMCA,LE MANS Study baseline,LE MANS Study LVEF at baseline and after 12 months,p=0.22,p=0.04,p=0.01,p=0.85,LE MANS Study CCS function class at baseline and follow-up,p=0.22,p=0.01,p=0.10,p=0.01,p=0.11,LE MANS Study treadmill stress tests at baseline and follow-up,p=0.03,p=0.31,p=0.97,p=0.53,LE MANS Study,PCI,CABG,Survival after PCI and CABG,MACCE-Free Survival after PCI and CABG,PCI,CABG,More RCT Trial Needed,ULMCA in Realistic World,Left Main Strategies,Ostium Lesions,Shaft Lesions,Bifurcation Lesions,What do you think about this patient,Male, 73y; Exertional Chest Pain 3m, Aggravated 10d; Diag: CAD UAP Braunwald B; Other RF: HT, Smoking; Echo: EF 68%, LVEDD 50mm; To Cath Lab.,4 Bifurcation Lesions,Which one is the first; Technique of each lesion; V/T/Kissing stent for LM; How to do the final kissing.,Crossover,T Stent,T Stent,Crush,GC: 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,SC: SES 2.5*18mm, SES 3.5*18mm,GW: Pilot50; BC: Sequent 3.0*10mm SC: SES 4.0*15mm,Final Result,CABG vs. DES our experiences,Lesions Distribution,From 2004 to 2006, 393 pts with LM lesions, FU 4y, Registry Study,255 pts in CABG Group & 138 pts in DES Group,Different Techniques of Bifurcation Lesions,CABG vs. DES our experiences,p0.05,p0.05,Prognosis -F