Cardiac Catheterization Laboratories, Department of Cardiology, Rabin Medical Center, Petach Tikva, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Catheter Cardiovasc Interv. 2012 Mar 1;79(4):615-22. doi: 10.1002/ccd.23180. Epub 2011 Dec 7.
To explore the long-term results following implantation of drug-eluting stents (DES) in bifurcation lesions according to contemporary "real world" practice.
Limited information is available on the long-term outcomes of patients with bifurcation lesions who are treated using DES. A systematic approach for bifurcation lesion management was applied, using either a "provisional" single stent technique or a dedicated two stents strategy according to the side-branch diameter and severity of its ostial stenosis.
Four hundred one consecutive patients underwent bifurcation percutaneous coronary intervention (PCI) using DES and were included in our prospective registry. All adverse events were recorded up to 2 years and distinguished according to the planned PCI strategy (e.g., one versus two stents technique).
A planned two stents strategy was used in 141 patients (35% of patients). In 260 patients (65%), the planned treatment involved stenting of the main branch only with "provisional" stenting of the side-branch according to procedural course. Thus, 24 patients (9.2%) needed additional stenting at the side-branch to complete the PCI. Cumulative major adverse cardiac event rate at 1 and 2 years was similar for both groups (11.4% vs. 14.8% at 1 year and 19.4% vs. 25.7% at 2 years for the single vs. two stents groups, accordingly, P = NS for both). Likewise, there was no difference in mortality, cardiac mortality, myocardial infarction, need for target lesions or target vessel revascularization, or definite stent thrombosis rate between the two groups at 6, 12, and 2 years follow-up. The rate of angiographically confirmed (i.e., definite) stent thrombosis did not differ between the two groups during follow-up.
Our study revealed favorable long-term clinical results following DES implantation using a systematic, rather simplified approach towards bifurcation stenting and using either a single or double stenting technique.
根据当代“真实世界”实践，探讨药物洗脱支架（DES）植入治疗分叉病变的长期结果。
关于使用 DES 治疗分叉病变患者的长期结果的信息有限。应用系统的方法治疗分叉病变，根据边支直径和开口狭窄程度，采用“临时”单支架技术或专用双支架策略。
连续 401 例患者接受 DES 分叉经皮冠状动脉介入治疗（PCI），并纳入前瞻性登记研究。所有不良事件均记录至 2 年，并根据计划的 PCI 策略（例如，单支架与双支架技术）进行区分。
141 例患者（35%的患者）计划采用双支架策略。260 例患者（65%）计划仅对主支进行支架置入，根据手术过程对边支进行“临时”支架置入。因此，24 例患者（9.2%）需要在边支进行额外的支架置入以完成 PCI。两组 1 年和 2 年时主要不良心脏事件发生率相似（单支架组分别为 11.4%和 14.8%，双支架组分别为 19.4%和 25.7%，P=NS 均无统计学差异）。同样，两组在 6、12 和 2 年随访时，死亡率、心脏死亡率、心肌梗死、靶病变或靶血管血运重建需要以及明确支架血栓形成率均无差异。在随访期间，两组的血管造影确认（即明确）支架血栓形成率无差异。
我们的研究显示，采用系统的、相对简化的方法治疗分叉病变，并采用单支架或双支架技术，DES 植入后具有良好的长期临床结果。
