Ojeda Soledad, Pan Manuel, Gutiérrez Alejandro, Romero Miguel, Chavarría Jorge, de Lezo Javier Suárez, Mazuelos Francisco, Pardo Laura, Hidalgo Francisco, Carrasco Francisco, Segura José, Durán Enrique, Ferreiro Carlos, Sánchez José J, Rodríguez Sara, Oneto Jesús, de Lezo Jose Suárez
Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
Int J Cardiol. 2017 Mar 1;230:432-438. doi: 10.1016/j.ijcard.2016.12.088. Epub 2016 Dec 21.
The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact.
BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was <III. Predictors of bifurcation success were baseline SB wiring (OR 0.01, 95% CI: 0.001-0.09; p<0.01), the absence of dissection across the bifurcation (OR 0.10, 95% CI: 0.02-0.49; p<0.01) and non-true BLs (OR 0.16, 95% CI: 0.04-0.68; p<0.05). Regarding in-hospital results, patients with final TIMI flow <III at the SB had a higher incidence of periprocedural MI (32% vs 4.8%; p<0.01). Subsequently, the rate of MI was higher in patients with CTO-BLs than in those without BLs. At follow-up, there were no differences in the event rate between CTO-BLs and non CTO-BLs (7.7% vs 9.5%, p=ns) CONCLUSIONS: BLs in CTO is a frequent finding and could be approached as regular bifurcations. The primary success was low and this was associated with a higher incidence of periprocedural MI. Baseline SB wiring was a powerful predictor of technical success.
在冠状动脉慢性完全闭塞（CTO）情况下出现分叉（BL）会带来额外困难。本研究分析了CTO再通中BL的发生率、治疗方法、分叉技术成功的预测因素及其临床影响。
在391例CTO患者中，130例（33%）观察到在闭塞段近端、远端或闭塞段内存在侧支（SB）≥2.0mm的BL。临时支架置入是最常用的策略（94%）。105例患者（81%）实现了分叉成功（主血管狭窄<30%且两支血管TIMI血流为III级）。其余25例（19%）患者的SB处TIMI血流<III级。分叉成功的预测因素包括基线SB导丝置入（比值比0.01，95%置信区间：0.001-0.09；p<0.01）、分叉处无夹层（比值比0.10，95%置信区间：0.02-0.49；p<0.01）和非真性BL（比值比0.16，95%置信区间：0.04-0.68；p<0.05）。关于院内结果，SB处最终TIMI血流<III级的患者围手术期心肌梗死发生率更高（32%对4.8%；p<0.01）。随后，CTO-BL患者的心肌梗死发生率高于无BL患者。随访时，CTO-BL患者与非CTO-BL患者的事件发生率无差异（7.7%对9.5%，p=无统计学意义）结论：CTO中的BL很常见，可按常规分叉处理。主要成功率较低，且与围手术期心肌梗死发生率较高相关。基线SB导丝置入是技术成功的有力预测因素。
