Biondi-Zoccai Giuseppe, Sheiban Imad, De Servi Stefano, Tamburino Corrado, Sangiorgi Giuseppe, Romagnoli Enrico
Department of Medico-Surgical Sciences and Biotechnology, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.
Heart Vessels. 2014 Nov;29(6):732-42. doi: 10.1007/s00380-013-0416-0.
Final kissing-balloon inflation is often recommended for percutaneous coronary intervention (PCI) of bifurcation lesions. However, randomized trials focusing on kissing inflation have not confirmed its beneficial impact. We compared outcomes of kissing inflation for PCI of bifurcation lesions, explicitly stratifying results according to stenting strategy. Patients undergoing bifurcation PCI were retrospectively enrolled. Subjects receiving final kissing inflation were compared with those not undergoing kissing inflation, after stratification for a single-stent technique. The primary end point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, or target lesion revascularization (TLR)). A total of 4314 patients were included: 1176 (27.3 %) treated with a single stent and kissing inflation, 1637 (37.9 %) with a single stent but no kissing, 1072 (24.8 %) with two stents and kissing, and 429 (9.9 %) with two stents but no kissing. At unadjusted analyses kissing was associated with fewer short-term MACE and deaths in the two-stent group, and with fewer long-term MACE, cardiac deaths, and side-branch TLR in the two-stent group (all P < 0.05). Conversely, kissing appeared detrimental after single stenting. However, after multivariable analyses, kissing no longer significantly affected the risk of adverse events, with the exception of the risk of side-branch TLR, which was lower in those receiving two stents and final kissing inflation (hazard ratio = 0.52, 95 % confidence interval 0.30–0.90, P = 0.020). Kissing inflation can be avoided in bifurcation lesions uneventfully treated with single-stent PCI. However, final kissing-balloon inflation appears beneficial in reducing the risk of side-branch repeat revascularization after using a two-stent strategy.
最终球囊对吻扩张术常用于分叉病变的经皮冠状动脉介入治疗（PCI）。然而，聚焦于对吻扩张的随机试验尚未证实其有益作用。我们比较了分叉病变PCI中对吻扩张术的结果，并根据支架置入策略明确分层分析结果。对接受分叉病变PCI的患者进行回顾性纳入研究。在按单支架技术分层后，将接受最终球囊对吻扩张的受试者与未接受对吻扩张的受试者进行比较。主要终点是主要不良心脏事件（MACE，即死亡、心肌梗死或靶病变血运重建（TLR））的长期发生率。共纳入4314例患者：1176例（27.3%）接受单支架及对吻扩张术治疗，1637例（37.9%）接受单支架但未行对吻扩张术，1072例（24.8%）接受双支架及对吻扩张术，429例（9.9%）接受双支架但未行对吻扩张术。在未校正分析中，对吻扩张术与双支架组较少的短期MACE和死亡相关，且与双支架组较少的长期MACE、心源性死亡和分支血管TLR相关（均P<0.05）。相反，在单支架置入术后对吻扩张术似乎有害。然而，经过多变量分析后，除分支血管TLR风险外，对吻扩张术不再显著影响不良事件风险，接受双支架及最终球囊对吻扩张术的患者分支血管TLR风险较低（风险比=0.52，95%置信区间0.30 - 0.90，P = 0.020）。在单支架PCI平稳治疗的分叉病变中可避免使用对吻扩张术。然而，最终球囊对吻扩张术似乎有利于降低双支架策略后分支血管再次血运重建的风险。
