D'Ascenzo Fabrizio, Iannaccone Mario, Giordana Francesca, Chieffo Alaide, Connor Stephen O, Napp L Christian, Chandran SujaySubash, de la Torre Hernández José María, Chen Shao-Liang, Varbella Ferdinando, Omedè Pierluigi, Taha Salma, Meliga Emanuele, Kawamoto Hiroyoshi, Montefusco Antonio, Chong Mervyn, Garot Philippe, Sin Lin, Gasparetto Valeria, Abdirashid Mohamed, Cerrato Enrico, Biondi-Zoccai Giuseppe, Gaita Fiorenzo, Escaned Javier, Hiddick Smith David, Lefèvre Thierry, Colombo Antonio, Sheiban Imad, Moretti Claudio
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy.
Int J Cardiol. 2016 May 15;211:37-42. doi: 10.1016/j.ijcard.2016.02.136. Epub 2016 Mar 3.
There is uncertainty on which stenting approach confers the best long-term outlook for unprotected left main (ULM) bifurcation disease.
This is a non-randomized, retrospective study including all consecutive patients with 50% stenosis of the left main involving at least 1 of the arteries stemming from the left main treated with drug-eluting stents (DES) in 9 European centers between 2002 and 2004. Patients were divided into two groups: those treated with provisional stentings vs. those treated with two stent strategy. The outcomes of interest were 10-year rates of target lesion revascularization (TLR), major adverse cardiac events (MACE), and their components (cardiovascular death, myocardial infarction [MI], or repeat revascularization), along with stent thrombosis (ST). A total of 285 patients were included, 178 (62.5%) in the provisional stenting group and 87 (37.5%) in the two stent group. After 10 years, no differences in TLR were found at unadjusted analysis (19% vs 25%, p>0.05) nor after propensity score matching (25% vs 28%, p>0.05). Similar rates of MACE (60% vs 66%, p>0.05), death (34% vs 43%, p>0.05), MI (9% vs 14%, p>0.05) and ST were also disclosed at propensity-based analysis.
Even after 10 year follow-up, patients treated with provisional stenting on left main showed comparable rates of target lesion revascularization compared to two stent strategy.
对于无保护左主干（ULM）分叉病变，哪种支架置入方法能带来最佳的长期预后尚不确定。
这是一项非随机、回顾性研究，纳入了2002年至2004年间在9个欧洲中心接受药物洗脱支架（DES）治疗的、左主干狭窄50%且至少累及一条发自左主干的动脉的所有连续患者。患者分为两组：临时支架置入组与双支架策略组。感兴趣的结局指标为靶病变血运重建（TLR）、主要不良心脏事件（MACE）及其组成部分（心血管死亡、心肌梗死[MI]或再次血运重建）的10年发生率，以及支架血栓形成（ST）。共纳入285例患者，临时支架置入组178例（62.5%），双支架组87例（37.5%）。10年后，未校正分析时TLR无差异（19%对25%，p>0.05），倾向评分匹配后也无差异（25%对28%，p>0.05）。基于倾向分析还发现MACE（60%对66%，p>0.05）、死亡（34%对43%，p>0.05）、MI（9%对14%，p>0.05）和ST的发生率相似。
即使经过10年随访，左主干采用临时支架置入治疗的患者与双支架策略相比，靶病变血运重建率相当。
