Gao Zhan, Xu Bo, Yang Yue-Jin, Qiao Shu-Bin, Wu Yong-Jian, Chen Tao, Xu Liang, Yuan Jin-Qing, Chen Jue, Qin Xue-Wen, Yao Min, Liu Hai-Bo, You Shi-Jie, Zhao Ye-Lin, Yan Hong-Bing, Chen Ji-Lin, Gao Run-Lin
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China.
Chin Med J (Engl). 2015 Mar 20;128(6):733-9. doi: 10.4103/0366-6999.152468.
Whether final kissing balloon (FKB) dilatation after one-stent implantation at left-main (LM) bifurcation site remains unclear. Therefore, this large sample and long-term follow-up study comparatively assessed the impact of FKB in patients with unprotected LM disease treated with one-stent strategy.
Total 1528 consecutive patients underwent LM percutaneous coronary intervention in one center from January 2004 to December 2010 were enrolled; among them, 790 patients treated with one drug-eluting stent crossover LM to left anterior descending (LAD) with FKB (n = 230) or no FKB (n = 560) were comparatively analyzed. Primary outcome was the rate of major adverse cardiovascular events, defined as a composite of death, myocardial infarction (MI) and target vessel revascularization (TVR).
Overall, The prevalence of true bifurcation lesions, which included Medina classification (1,1,1), (1,0,1), or (0,1,1), was similar between-groups (non-FKB: 37.0% vs. FKB: 39.6%, P = 0.49). At mean 4 years follow-up, rates of major adverse cardiovascular events (non-FKB: 10.0% vs. FKB: 7.8%, P = 0.33), death, MI and TVR were not significantly different between-groups. In multivariate propensity-matched regression analysis, FKB was not an independent predictor of adverse outcomes.
For patients treated with one-stent crossover LM to LAD, clinical outcomes appear similar between FKB and non-FKB strategy.
在左主干（LM）分叉部位植入一枚支架后进行最终球囊亲吻（FKB）扩张是否有益仍不明确。因此，本大样本长期随访研究比较评估了FKB对采用单支架策略治疗的无保护左主干病变患者的影响。
纳入2004年1月至2010年12月在同一中心连续接受LM经皮冠状动脉介入治疗的1528例患者；其中，对790例采用一枚药物洗脱支架从LM交叉至左前降支（LAD）并接受FKB（n = 230）或未接受FKB（n = 560）的患者进行了比较分析。主要结局是主要不良心血管事件发生率，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，两组间真性分叉病变（包括Medina分型为(1,1,1)、(1,0,1)或(0,1,1)）的患病率相似（未行FKB组：37.0% vs. FKB组：39.6%，P = 0.49）。在平均4年的随访中，两组间主要不良心血管事件发生率（未行FKB组：10.0% vs. FKB组：7.8%，P = 0.33）、死亡、MI和TVR无显著差异。在多因素倾向匹配回归分析中，FKB不是不良结局的独立预测因素。
对于采用单支架从LM交叉至LAD治疗的患者，FKB和未行FKB策略的临床结局相似。
