Gao Zhan, Xu Bo, Yang Yuejin, Qiao Shubin, Wu Yongjian, Chen Tao, Xu Liang, Yuan Jinqing, Chen Jue, Gao Run-lin
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Catheter Cardiovasc Interv. 2015 Jun;85(7):1132-8. doi: 10.1002/ccd.25849. Epub 2015 Feb 18.
Comparisons between one- and two-stent strategies for unprotected left main (UPLM) coronary bifurcation disease have yielded inconsistent results. This large-sample, long-term follow-up study comparatively assessed stenting strategy impact in patients with distal left main disease.
Totally, 1,528 consecutive patients underwent left main percutaneous coronary intervention in a single center from January 2004 to December 2010 were enrolled; among them, 1033 patients with distal UPLM lesions treated by one (n = 661) or two (n = 372) drug-eluting stent (DES) technique were comparatively analyzed. Primary outcome was rate of major adverse cardiovascular events (MACE), defined as a composite of death, myocardial infarction (MI), and target vessel revascularization (TVR).
Overall, baseline SYNTAX score was low-intermediate (one stent: 25 ± 6 vs. two stents: 26 ± 5, P = 0.02), and mean clinical SYNTAX score was similar between groups (one stent: 30 ± 22 vs. two stents: 31 ± 22, P = 0.47). Final kissing balloon was successfully achieved in most of the patients treated with two-stent technique (one stent: 30.9% vs. two stents: 96.0%, P < 0.01), and use of intravascular ultrasound was also more common in them (one stent: 32.2% vs. two stents: 53.8%, P < 0.01). At mean 4 years follow-up, rates of MACE (one stent: 9.2% vs. two stents: 11.6%, P = 0.23), death, MI, and TVR were similar between groups. In multivariate propensity-matched regression analysis, two-stent technique was not predictive of MACE.
For patients with distal UPLM disease and low-intermediate SYNTAX score treated with DES, clinical outcomes appear similar between optimal two-stent implantation and one-stent strategy. © 2015 Wiley Periodicals, Inc.
对于无保护左主干（UPLM）冠状动脉分叉病变，单支架与双支架策略的比较结果并不一致。这项大样本、长期随访研究比较评估了左主干远端病变患者的支架置入策略影响。
纳入2004年1月至2010年12月在单一中心连续接受左主干经皮冠状动脉介入治疗的1528例患者；其中，对采用单支架（n = 661）或双支架（n = 372）药物洗脱支架（DES）技术治疗的1033例UPLM远端病变患者进行了比较分析。主要结局是主要不良心血管事件（MACE）发生率，定义为死亡、心肌梗死（MI）和靶血管血运重建（TVR）的复合事件。
总体而言，基线SYNTAX评分处于低-中度（单支架：25±6 vs双支架：26±5，P = 0.02），两组间平均临床SYNTAX评分相似（单支架：30±22 vs双支架：31±22，P = 0.47）。大多数接受双支架技术治疗的患者成功完成了最终球囊对吻扩张（单支架：30.9% vs双支架：96.0%，P < 0.01），并且他们使用血管内超声也更为常见（单支架：32.2% vs双支架：53.8%，P < 0.01）。在平均4年的随访中，两组间MACE发生率（单支架：9.2% vs双支架：11.6%，P = 0.23）、死亡率、MI发生率和TVR相似。在多因素倾向匹配回归分析中，双支架技术不能预测MACE。
对于采用DES治疗的UPLM远端病变且SYNTAX评分低-中度的患者，最佳双支架置入与单支架策略的临床结局似乎相似。©2015威利期刊公司。
