Fan Lin, Chen Lianglong, Luo Yukun, Zhang Linlin, Zhong Wenliang, Lin Chaogui, Chen Zhaoyang, Peng Yafei, Zhen Xingchun, Dong Xianfeng
Department of Cardiology, Union Hospital, Fujian Medical University, Fujian, China.
Institute of Coronary Heart Disease, Fujian, China.
Heart Vessels. 2016 Mar;31(3):308-21. doi: 10.1007/s00380-014-0611-7. Epub 2014 Dec 17.
The conventional culotte technique remains not to be widely used for the treatment of coronary bifurcation lesions due to its inherent drawbacks. Here, we developed a double kissing mini-culotte stenting (DK mini-culotte) and assessed its efficacy and safety by a propensity score matching comparison (PSM) with T-provisional stenting. From June 2010 to June 2012, a total of 223 consecutive patients with true coronary bifurcation lesions (TCBLs) were treated with DK mini-culotte (91 patients with 92 lesions) or T-provisional stenting (132 patients with 135 lesions). We performed a PSM to correct the confounders from clinical and lesion's characteristics. The primary endpoint was cumulative major adverse cardiac event (MACE) at 1 year including cardiac death, myocardial infarction, and target vessel revascularization or target lesion revascularization (TVR/TLR). The secondary endpoint was the rate of side branch (SB) restenosis at 12 months. After a PSM, there were 66 patients in each group. Additional SB stenting in the T-provisional group was performed in 10 (15.2 %) lesions. The incidence of 1-year cumulative MACE was 4.55 % for the DK mini-culotte versus 13.6 % for T-provisional stenting (P = 0.127), the rate of TVR/TLR was 1.52 % for DK mini-culotte versus 12.12 % for T-provisional stenting (P = 0.033). The SB binary restenosis rate was 5.6 % in the DK mini-culotte group and 22.4 % in the T-provisional group (P = 0.014). In summary, despite that there is no difference in MACE between groups, DK mini-culotte significantly reduce TVR/TLR and SB restenosis in the treatment of true coronary bifurcation lesions.
由于传统裤裙式技术存在固有缺陷，其在冠状动脉分叉病变治疗中的应用仍未广泛普及。在此，我们研发了双吻迷你裤裙式支架置入术（DK迷你裤裙式），并通过倾向评分匹配比较（PSM）与T-临时支架置入术对比，评估其有效性和安全性。2010年6月至2012年6月，共有223例连续性真性冠状动脉分叉病变（TCBL）患者接受了DK迷你裤裙式治疗（91例患者，92处病变）或T-临时支架置入术（132例患者，135处病变）。我们进行了PSM以校正临床和病变特征方面的混杂因素。主要终点为1年时的累积主要不良心脏事件（MACE），包括心源性死亡、心肌梗死以及靶血管血运重建或靶病变血运重建（TVR/TLR）。次要终点为12个月时边支（SB）再狭窄率。经过PSM后，每组各有66例患者。T-临时组中有10处（15.2%）病变进行了额外的SB支架置入。DK迷你裤裙式组1年累积MACE发生率为4.55%，T-临时支架置入术组为13.6%（P = 0.127），DK迷你裤裙式组TVR/TLR率为1.52%，T-临时支架置入术组为12.12%（P = 0.033）。DK迷你裤裙式组SB二元再狭窄率为5.6%，T-临时组为22.4%（P = 0.014）。总之，尽管两组间MACE无差异，但在真性冠状动脉分叉病变治疗中，DK迷你裤裙式显著降低了TVR/TLR和SB再狭窄率。
