Jang Woo Jin, Park Yong Hwan, Hahn Joo-Yong, Song Young Bin, Choi Seung-Hyuk, Chun Woo Jung, Hyeon Oh Ju, Koo Bon-Kwon, Rha Seung Woon, Jang Yangsoo, Tahk Seung-Jea, Kim Hyo-Soo, Gwon Hyeon-Cheol
Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Cardiol. 2016 Oct 15;221:471-7. doi: 10.1016/j.ijcard.2016.07.045. Epub 2016 Jul 6.
Indication of side branch (SB) intervention after main vessel (MV) stenting is not established for coronary bifurcation lesions.
We evaluated 2017 patients who were treated with 1-stent technique or MV stenting as a first strategy. Patients undergoing SB intervention after MV stenting (SB intervention group, n=929) were compared to those treated with MV stenting only (no-SB intervention group, n=1088).
During a median follow-up of 37months, cardiac death or myocardial infarction (MI) tended to occur less frequently in the SB intervention group than in the no-SB intervention group (1.8% versus 2.9%; adjusted hazard ratio [HR] 0.53; 95% confidence interval [CI] 0.25-1.11; P=0.09). There was a significant interaction between SB intervention and SB stenosis after MV stenting (P for interaction <0.01). Among 1077 patients with diameter stenosis of SB ≥50% after MV stenting, SB intervention was associated with a lower risk of cardiac death or MI (1.2% versus 4.2%; adjusted HR 0.22; 95% CI 0.09-0.52; P<0.01). However, among 940 patients with diameter stenosis of SB <50%, there was no significant difference in cardiac death or MI between the SB intervention group and the no-SB intervention group (3.5% versus 2.2%; adjusted HR 1.36; 95% CI 0.58-3.20; P=0.48).
The effect of SB intervention differed according to SB stenosis after MV stenting. SB intervention may reduce cardiac death or MI in bifurcation lesions with diameter stenosis of SB ≥50% after MV stenting.
对于冠状动脉分叉病变，在主血管（MV）支架置入术后进行边支（SB）干预的指征尚未明确。
我们评估了2017例采用单支架技术或MV支架置入作为首要策略进行治疗的患者。将MV支架置入术后接受SB干预的患者（SB干预组，n = 929）与仅接受MV支架置入的患者（无SB干预组，n = 1088）进行比较。
在中位随访37个月期间，SB干预组中心脏性死亡或心肌梗死（MI）的发生率往往低于无SB干预组（1.8% 对2.9%；校正风险比[HR] 0.53；95%置信区间[CI] 0.25 - 1.11；P = 0.09）。MV支架置入术后SB干预与SB狭窄之间存在显著交互作用（交互作用P<0.01）。在MV支架置入术后SB直径狭窄≥50%的1077例患者中，SB干预与较低的心脏性死亡或MI风险相关（1.2% 对4.2%；校正HR 0.22；95% CI 0.09 - 0.52；P<0.01）。然而，在SB直径狭窄<50%的940例患者中，SB干预组与无SB干预组在心脏性死亡或MI方面无显著差异（3.5% 对2.2%；校正HR 1.36；95% CI 0.58 - 3.20；P = 0.48）。
MV支架置入术后SB干预的效果因SB狭窄情况而异。SB干预可能会降低MV支架置入术后SB直径狭窄≥50%的分叉病变患者的心脏性死亡或MI风险。
