Zusammenfassung
Hintergrund:
Die Stentversorgung von isolierten proximalen LAD-Stenosen wird immer noch kontrovers diskutiert, wegen höherer Restenoserate und wegen der überzeugenden chirurgischen Alternative eines Mammaria interna Bypasses. Der Sirolimus-Eluting-Stent (SES) hat die Restenoserate bei De-novo Koronarläsionen deutlich verringert. Wir haben daher Patienten aus dem deutschen Cypher Register mit isolierten Läsionen der proximalen LAD mit Patienten verglichen die an isolierten Läsionen der proximalen LCX oder RCA behandelt worden sind.
Methoden
Eine Gesamtanzahl von 349 Patienten die mittels SES behandelt worden sind, wurden analysiert. Es wurden 249 Patienten mit proximaler LAD-Stenose und 100 Patienten mit proximalen LCX/RCA-Stenosen behandelt. Der kombinierte klinische Endpunkt war MACCE (Tod jeder Ursache, nicht tödlicher Myokardinfarkt, nicht tödlicher Schlaganfall) und Zielgefäßrevaskularisation nach 6 Monaten.
Ergebnisse
Die intrahospitalen Ereignisse (Tod, Myokardinfarkt, Zielgefäßrevaskularisation) zeigten keine signifikanten Unterschiede beider Gruppen (3,2% in der LAD-Gruppe versus 2,0% in der LCX/RCA-Gruppe p = 0,73). Nach 6 Monaten war die MACCE Rate 2,6% in der LAD-Gruppe und 2,2% in der LCX/RCA-Gruppe (p=0,73). Die Zielgefäßrevaskularisationsrate (TVR) war 4,8% in der LAD-Gruppe und 6,5% in der LCX/RCA-Gruppe (p=0,58). Der Anteil kardial beschwerdefreier Patienten (keine Angina bei alltäglicher Belastung) war 80,6% in der LAD-Gruppe und 77,4% in der LCX/RCA-Gruppe (p=0,52).
Schlussfolgerung
SES-Implantation von isolierten proximalen LADStenosen scheint genauso effektiv zu sein , wie in anderen Gefäßterritorien. Folglich könnte die Stentversorgung der proximalen LAD mit SES eine Alternative zur Bypasschirurgie werden.
Summary
Background
Stenting of isolated proximal LAD stenoses is still a controversial issue since it is associated with higher target vessel revascularization (TVR) rate than both bypass surgery using the internal mammary artery, and stenting of other coronary artery territories. The sirolimus- eluting stent (SES) has been reported to significantly reduce restenosis rates in de novo coronary lesions. Therefore, we compared patients from the German Cypher Registry treated with SES for isolated proximal LAD lesions with those stented for isolated lesions in the proximal LCX or RCA.
Methods
A total of 349 patients treated with SES were analyzed. 249 patients were treated for proximal LAD stenosis, and 100 for proximal LCX/RCA stenoses. The combined clinical endpoint was MACCE (death of any cause, non-fatal MI and non-fatal stroke) and TVR at 6 months.
Results
In-hospital events (death, MI and TVR) did not differ significantly between both groups (3.2% for the LAD group vs 2.0% for the LCX/RCA-group, p=0.73). The combined end point of death of any cause, non-fatal MI and non-fatal stroke at six months was 2.6% in the LAD group, and 2.2% in the LCX/RCA group (p=1.0). TVR occurred in 4.8% of the LAD group and in 6.5% of the LCX/RCA group at six months (p=0.58). The percentage of patients free from angina at daily activities was 80.6% in the LAD group, and 77.4% in the LCX/ RCA group (p=0.52).
Conclusion
SES once implanted into isolated proximal LAD stenoses appears as effective as reported in other vessel territories. Accordingly, stenting of the proximal LAD using SES might prove a suitable alternative to surgery.
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Khattab, A.A., Hamm, C.W., Senges, J. et al. Sirolimus-eluting stent treatment for isolated proximal left anterior descending artery stenoses. ZS Kardiologie 94, 187–192 (2005). https://doi.org/10.1007/s00392-005-0200-y
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DOI: https://doi.org/10.1007/s00392-005-0200-y