药物洗脱支架挤压术：冠状动脉分叉病变位置对血管造影和临床结果的相关性。

Crush stenting with drug-eluting stents: relevance of coronary bifurcation lesion location on angiographic and clinical outcomes.

机构信息

Nanjing First Hospital, Nanjing Medical University, China.

出版信息

Clin Cardiol. 2010 Dec;33(12):E32-9. doi: 10.1002/clc.20544. Epub 2010 Sep 20.

DOI:10.1002/clc.20544

PMID:20857513

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6652929/

Abstract

BACKGROUND

Data on the relevance of the location of coronary bifurcation lesions treated by crush stenting with outcomes were limited.

HYPOTHESIS

We hypothesized that the location of the bifurcation lesion correlated with clinical outcome.

METHOD

A total of 212 patients with 230 true bifurcation lesions treated by crush stenting with drug-eluting stents (DES) were assessed prospectively. Surveillance quantitative angiographies were indexed at 8 months after procedure. Primary endpoint was major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, and target lesion revascularization (TLR).

RESULTS

Patients in the distal right coronary artery (RCAd) group were characterized by higher proportions of prior myocardial infarction and very tortuous lesions. However, lesions in the RCAd group, compared to those of other groups, had the lowest late lumen loss, with resultant lowest incidence of MACE at a mean follow-up of 268±35 days. Independent predictors of MACE included unsatisfied kissing (KUS; hazard ratio [HR]: 12.14, 95% confidence interval [CI]: 4.01-12.10, P = .001) and non-RCA lesion (HR: 20.69, 95% CI: 5.05-22.38, P = .001), while those of TLR were KUS (HR: 10.21, 95% CI: 0.01-0.34, P = .002), bifurcation angle (HR: 4.728, 95% CI: 2.541-4.109, P = .001), and non-RCA lesion (HR: 16.05, 95%CI: 1.01-4.83, P = .001).

CONCLUSIONS

Classical crush stenting with drug-eluting stents is associated with significantly better outcomes in RCAd. Quality of kissing inflation is mandatory to improve outcome.

摘要

背景

关于采用挤压支架术治疗的冠状动脉分叉病变部位与结果之间的相关性的数据有限。

假设

我们假设分叉病变的位置与临床结果相关。

方法

前瞻性评估了 212 例采用药物洗脱支架（DES）行挤压支架术治疗的 230 例真性分叉病变患者。术后 8 个月进行监测定量血管造影。主要终点为主要不良心脏事件（MACE），定义为心脏死亡、心肌梗死和靶病变血运重建（TLR）。

结果

右冠状动脉远段（RCAd）组患者既往心肌梗死和非常迂曲病变的比例较高。然而，与其他组相比，RCAd 组的病变晚期管腔丢失最低，在平均 268±35 天的随访中，MACE 的发生率最低。MACE 的独立预测因素包括不满意的吻合并置（KUS；危险比[HR]：12.14，95%置信区间[CI]：4.01-12.10，P=.001）和非 RCA 病变（HR：20.69，95%CI：5.05-22.38，P=.001），而 TLR 的独立预测因素包括 KUS（HR：10.21，95%CI：0.01-0.34，P=.002）、分叉角度（HR：4.728，95%CI：2.541-4.109，P=.001）和非 RCA 病变（HR：16.05，95%CI：1.01-4.83，P=.001）。