Routledge Helen C, Morice Marie-Claude, Lefèvre Thierry, Garot Philippe, De Marco Federico, Vaquerizo Beatriz, Louvard Yves
ICPS Institut Cardiovasculaire, Paris Sud, Massy, France.
JACC Cardiovasc Interv. 2008 Aug;1(4):358-65. doi: 10.1016/j.jcin.2008.05.005.
Our goal was to determine whether the deployment of drug-eluting stents (DES) in bifurcation lesions, according to a uniform provisional side-branch T-stenting strategy (PTS), is a safe and effective treatment in the immediate and long term.
In comparison with simple stenoses, successful percutaneous intervention for coronary bifurcation lesions is limited by a higher incidence of procedural complications and need for repeat revascularization. The ideal strategy to overcome these limitations remains to be demonstrated while recent controversy surrounds the long-term safety of DES in bifurcations.
Consecutive patients treated for bifurcation lesions using DES were studied in a prospective single-center registry. Between 2003 to 2005, 477 procedures were performed. The PTS strategy was used in 92%, with a side-branch stent in 28% and final kissing balloon inflation in 95%.
Angiographic success was achieved in 99% with 2.5% in-hospital major adverse cardiac events. The cumulative rate of major adverse cardiac events was 10.7% at 1 year and 13.6% at 2 years, including 6.9% and 8.9% target vessel revascularization. Deviation from the PTS strategy independently predicted 2-year mortality (odds ratio: 5.5 [95% confidence interval: 1.63 to 18.3], p < 0.01). The rate of definite or probable stent thrombosis at 2 years was 2.5% with half of all events occurring before hospital discharge.
The PTS strategy for the treatment of bifurcation lesions is applicable to over 90% of patients in the real world. With DES, both safety and efficacy have been demonstrated in the long-term with <10% need for repeat revascularization in the first 2 years and a low incidence of late stent thrombosis.
我们的目标是确定根据统一的临时分支T型支架置入策略（PTS）在分叉病变中植入药物洗脱支架（DES）在近期和长期是否为安全有效的治疗方法。
与单纯狭窄相比，冠状动脉分叉病变的成功经皮介入治疗受到手术并发症发生率较高和需要重复血运重建的限制。克服这些限制的理想策略仍有待证明，而近期关于DES在分叉病变中的长期安全性存在争议。
在一项前瞻性单中心登记研究中，对使用DES治疗分叉病变的连续患者进行研究。2003年至2005年期间，共进行了477例手术。92%的患者采用了PTS策略，28%的患者置入了分支支架，95%的患者进行了最终球囊对吻扩张。
血管造影成功率为99%，住院期间主要不良心脏事件发生率为2.5%。1年时主要不良心脏事件的累积发生率为10.7%，2年时为13.6%，包括6.9%和8.9%的靶血管血运重建。偏离PTS策略可独立预测2年死亡率（比值比：5.5[95%置信区间：1.63至18.3]，p<0.01）。2年时明确或可能的支架血栓形成率为2.5%，所有事件的一半发生在出院前。
治疗分叉病变的PTS策略适用于现实世界中超过90%的患者。使用DES，长期安全性和有效性均得到证实，前2年重复血运重建的需求<10%，晚期支架血栓形成发生率低。
