Garot Philippe, Lefèvre Thierry, Savage Michael, Louvard Yves, Bamlet William R, Willerson James T, Morice Marie-Claude, Holmes David R
Institut Cardio-vasculaire Paris Sud, Quincy, France.
J Am Coll Cardiol. 2005 Aug 16;46(4):606-12. doi: 10.1016/j.jacc.2005.01.065.
The aim of this research was to determine the influence of bifurcation lesions on the outcome of patients undergoing percutaneous coronary intervention (PCI) in the recent era.
The treatment of bifurcation lesions by PCI has been associated with an increased complication rate. Whether recent improvements of interventional practice have translated into improved outcomes in this patient subgroup is unknown.
The 11,482 patients enrolled in the Prevention of Restenosis with Tranilast and its Outcomes (PRESTO) were stratified according to the presence (n = 1,412) or absence (n = 10,068) of at least one bifurcation lesion treated by PCI. Baseline characteristics and outcome of patients undergoing PCI for bifurcation lesions were compared to those of patients treated for nonbifurcation lesions.
Patients treated for bifurcation lesions were less likely to have prior myocardial infarction (MI), prior coronary artery bypass graft surgery, and had a higher proportion of current stable angina (p < 0.01 for all comparisons). Bifurcation lesions involved more frequently the left anterior descending coronary artery and were more complex (angulated, eccentric, ostial, and tortuous) than nonbifurcation lesions. Percutaneous coronary intervention of bifurcation lesions was characterized by less frequent stent implantation (71% vs. 80%); PCI of bifurcation lesions was associated with an increased rate of combined end point death/MI/target vessel revascularization (TVR) at nine months (18% vs. 15%, p = 0.002) because of increased rates of TVR (17% vs. 14%, p < 0.001), whereas death (1%) and MI (1%) were not different between groups.
Percutaneous coronary intervention of bifurcation lesions is associated with higher TVR at follow-up. However, the risk of death, MI, death/MI was similar in patients treated for bifurcation or nonbifurcation lesions.
本研究旨在确定近期时代分叉病变对接受经皮冠状动脉介入治疗（PCI）患者预后的影响。
PCI治疗分叉病变与并发症发生率增加有关。介入治疗实践的近期改善是否已转化为该患者亚组预后的改善尚不清楚。
将参加曲尼司特预防再狭窄及其结果（PRESTO）研究的11482例患者根据是否存在至少一处接受PCI治疗的分叉病变进行分层（存在分叉病变者n = 1412例，不存在分叉病变者n = 10068例）。将接受PCI治疗分叉病变患者的基线特征和预后与接受非分叉病变治疗患者的进行比较。
接受分叉病变治疗的患者既往心肌梗死（MI）、既往冠状动脉旁路移植手术的可能性较小，且当前稳定型心绞痛的比例较高（所有比较p < 0.01）。与非分叉病变相比，分叉病变更常累及左前降支冠状动脉，且更复杂（成角、偏心、开口处、迂曲）。分叉病变的PCI特点是支架植入频率较低（71%对80%）；由于靶血管重建（TVR）率增加，分叉病变的PCI在9个月时联合终点死亡/MI/TVR的发生率增加（18%对15%，p = 0.002），而TVR率为（17%对14%，p < 0.001），而两组间死亡（1%）和MI（1%）无差异。
分叉病变的PCI在随访时与较高的TVR相关。然而，接受分叉或非分叉病变治疗的患者死亡、MI、死亡/MI的风险相似。
