Zhang F, Dong L, Ge J
Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China.
Heart. 2009 Oct;95(20):1676-81. doi: 10.1136/hrt.2009.168641. Epub 2009 Jul 29.
Coronary bifurcation lesions remain a challenge for interventional cardiologists and the optimal stenting strategy has not been established in the current drug-eluting stent (DES) era. This study compared two strategies for DES treatment of coronary bifurcation lesions: a simple stenting approach (stenting only the main vessel (MV) and provisional stenting of the side branch (SB) only when bailout of the SB is necessary) versus a complex stenting approach (routinely stenting not only MV but also SB).
Data sources included PubMed and conference proceedings. Prespecified criteria were met by five randomised studies comparing simple stenting strategy versus complex stenting strategy in 1553 patients with coronary bifurcation lesions. Studies reported the clinical and angiographic outcomes of efficacy and safety during a minimum of 6 months.
The risks of follow-up myocardial infarction (MI) (relative ratio (RR) 0.54, 95% confidence interval (CI) 0.37 to 0.78, p = 0.001) and early (in-hospital or 30-day) MI (RR 0.52, 95% CI 0.35 to 0.78, p = 0.002) were markedly lower in patients treated with the simple strategy compared to the complex strategy. There were no significant differences between the two different strategies with respect to the rates of cardiac death (RR 0.68, 95% CI 0.21 to 2.25, p = 0.53), target lesion revascularisation (TLR) (RR 0.93, 95% CI 0.62 to 1.41, p = 0.74) or definite stent thrombosis (ST) (RR 0.50, 95% CI 0.19 to 1.32, p = 0.16). The restenosis risk of MV and SB did not differ between the simple strategy group and the complex strategy group (RR 1.15, 95% CI 0.66 to 2.00, p = 0.63 and RR 1.12, 95% CI 0.80 to 1.57, p = 0.50, respectively).
Compared to the complex strategy for DES treatment of coronary bifurcation lesions, the simple strategy was associated with a lower risk of early MI and a similar rate of angiographic restenosis. Since the complex strategy could not improve the clinical or angiographic outcome, the simple strategy can be recommended as a preferred bifurcation stenting technique in the DES era.
冠状动脉分叉病变对介入心脏病学家来说仍是一项挑战，在当前药物洗脱支架（DES）时代，最佳的支架置入策略尚未确立。本研究比较了DES治疗冠状动脉分叉病变的两种策略：一种简单的支架置入方法（仅对主支血管（MV）进行支架置入，仅在必要时对边支血管（SB）进行补救性临时支架置入）与一种复杂的支架置入方法（不仅常规对MV而且对SB进行支架置入）。
数据来源包括PubMed和会议论文集。五项随机研究符合预先设定的标准，这些研究比较了1553例冠状动脉分叉病变患者的简单支架置入策略与复杂支架置入策略。研究报告了至少6个月期间的临床和血管造影的疗效及安全性结果。
与复杂策略相比，采用简单策略治疗的患者随访期心肌梗死（MI）风险（相对比（RR）0.54，95%置信区间（CI）0.37至0.78，p = 0.001）和早期（住院期间或30天内）MI风险（RR 0.52，95%CI 0.35至0.78，p = 0.002）明显更低。两种不同策略在心脏死亡发生率（RR 0.68，95%CI 0.21至2.25，p = 0.53）、靶病变血运重建（TLR）率（RR 0.93，95%CI 0.62至1.41，p = 0.74）或明确的支架内血栓形成（ST）率（RR 0.50，95%CI 0.19至1.32，p = 0.16）方面无显著差异。简单策略组与复杂策略组MV和SB的再狭窄风险无差异（RR分别为1.15，95%CI 0.66至2.00，p = 0.63和RR 1.12，95%CI 0.80至1.57，p = 0.50）。
与DES治疗冠状动脉分叉病变的复杂策略相比，简单策略与更低的早期MI风险及相似的血管造影再狭窄率相关。由于复杂策略不能改善临床或血管造影结果，在DES时代，简单策略可被推荐为首选的分叉病变支架置入技术。
