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1、左主支疾病：医学证据基础左主支疾病：医学证据基础和现实世界（英文课件）和现实世界（英文课件）Anatomy importance of LMoCompromises flow to approximately 75%of the left ventricle;oAcute occlusion of ULMCA will cause MI,cardiac shock or acute heart failure,cardiac arrest(50%70%).Recent Meta-Analysis of 1,278 Patients Undergoing UPLM DES From 15 Reg
2、istriesDate 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 in LE MA
3、NS Registry:225Randomized patients:105Nonrandomized patients:17PCI102CABG123PCI52CABG53PCI9CABG8All 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(%)60730.13CCS class3.11.02.81.
4、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=0.01p=0.85LE MANS Study CCS func
5、tion 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 in Realistic WorldLeft Main S
6、trategiesOstium 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 first;oTechnique of each lesion;oV
7、/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:Sequent 3.0*10mm SC:SES 4.0*15mmFinal ResultCABG vs.DES
8、 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%ThanksThanks结束语结束语谢谢大家聆听！谢谢大家聆听！31