Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Chonnam National University Hospital, Gwangju, Republic of Korea.
JACC Cardiovasc Interv. 2014 Mar;7(3):255-63. doi: 10.1016/j.jcin.2013.11.009. Epub 2014 Feb 13.
The authors sought to investigate whether the impact of treatment strategies on clinical outcomes differed between patients with left main (LM) bifurcation lesions and those with non-LM bifurcation lesions.
Few studies have considered anatomic location when comparing 1- and 2-stent strategies for bifurcation lesions.
We compared the prognostic impact of treatment strategies on clinical outcomes in 2,044 patients with non-LM bifurcation lesions and 853 with LM bifurcation lesions. The primary outcome was target lesion failure (TLF) defined as a composite of cardiac death, myocardial infarction (MI), and target lesion revascularization.
The 2-stent strategy was used more frequently in the LM bifurcation group than in the non-LM bifurcation group (40.3% vs. 20.8%, p < 0.01). During a median follow-up of 36 months, the 2-stent strategy was not associated with a higher incidence of cardiac death (hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 0.72 to 2.14; p = 0.44), cardiac death or MI (HR: 1.12; 95% CI: 0.58 to 2.19; p = 0.73), or TLF (HR: 1.39; 95% CI: 0.99 to 1.94; p = 0.06) in the non-LM bifurcation group. In contrast, in patients with LM bifurcation lesions, the 2-stent strategy was associated with a higher incidence of cardiac death (HR: 2.43; 95% CI: 1.05 to 5.59; p = 0.04), cardiac death or MI (HR: 2.09; 95% CI: 1.08 to 4.04; p = 0.03), as well as TLF (HR: 2.38; 95% CI: 1.60 to 3.55; p < 0.01). Significant interactions were present between treatment strategies and bifurcation lesion locations for TLF (p = 0.01).
The 1-stent strategy, if possible, should initially be considered the preferred approach for the treatment of coronary bifurcation lesions, especially LM bifurcation lesions. (Korean Coronary Bifurcation Stenting [COBIS] Registry II; NCT01642992).
作者旨在研究治疗策略对左主干（LM）分叉病变患者和非 LM 分叉病变患者临床结局的影响是否存在差异。
很少有研究在比较分叉病变的 1 支架和 2 支架策略时考虑解剖位置。
我们比较了 2044 例非 LM 分叉病变患者和 853 例 LM 分叉病变患者的治疗策略对临床结局的预后影响。主要终点是靶病变失败（TLF），定义为心脏死亡、心肌梗死（MI）和靶病变血运重建的复合终点。
在 LM 分叉病变组中，2 支架策略的使用率高于非 LM 分叉病变组（40.3% vs. 20.8%，p<0.01）。在中位随访 36 个月期间，2 支架策略与非 LM 分叉病变组心脏死亡（风险比 [HR]：1.24；95%置信区间 [CI]：0.72 至 2.14；p=0.44）、心脏死亡或 MI（HR：1.12；95% CI：0.58 至 2.19；p=0.73）或 TLF（HR：1.39；95% CI：0.99 至 1.94；p=0.06）发生率增加无关。相比之下，在 LM 分叉病变患者中，2 支架策略与心脏死亡（HR：2.43；95% CI：1.05 至 5.59；p=0.04）、心脏死亡或 MI（HR：2.09；95% CI：1.08 至 4.04；p=0.03）以及 TLF（HR：2.38；95% CI：1.60 至 3.55；p<0.01）发生率增加相关。在 TLF 方面，治疗策略和分叉病变位置之间存在显著的交互作用（p=0.01）。
如果可能的话，1 支架策略应首先被视为治疗冠状动脉分叉病变的首选方法，尤其是 LM 分叉病变。（韩国冠状动脉分叉支架置入研究 [COBIS] II 期；NCT01642992）。
