Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
EuroIntervention. 2017 Sep 20;13(7):835-842. doi: 10.4244/EIJ-D-16-01004.
It has not been known which two-stent technique is best for treating bifurcation lesions. We aimed to compare the outcomes from main vessel (MV) first and side branch (SB) first techniques for patients with bifurcation lesions requiring a two-stent approach.
A total of 673 patients with bifurcation lesions were treated with two-stent techniques: MV first (n=250) or SB first (n=423). The rate of a composite of cardiac death, myocardial infarction, or target lesion revascularisation (TLR) was similar in the two groups (SB first versus MV first, 15.1% versus 15.6% in the total population [p=0.90]; 14.3% versus 17.4% in a propensity score-matched population [p=0.80]). There were significant interactions associated with TLR risk between MV and SB first techniques according to angiographic factors. Patients in the MV first group had a lower risk of TLR when they had a lesion with MV diameter stenosis ≥70% (p for interaction=0.04), more severe stenosis of the MV than of the SB (p for interaction=0.008), or MV lesion length ≥18 mm (p for interaction=0.01).
Clinical outcomes were similar for patients treated with MV or SB first two-stent techniques. Using "more severe lesion first" two-stent techniques might offer a favourable prognosis.
目前尚不清楚哪种双支架技术治疗分叉病变最好。我们旨在比较主血管（MV）优先和分支血管（SB）优先技术治疗需要双支架治疗的分叉病变患者的结果。
共有 673 例分叉病变患者接受了双支架技术治疗：MV 优先（n=250）或 SB 优先（n=423）。两组患者的复合终点（心脏死亡、心肌梗死或靶病变血运重建[TLR]）发生率相似（总人群中 SB 优先组与 MV 优先组分别为 15.1%和 15.6%[p=0.90]；倾向评分匹配人群中分别为 14.3%和 17.4%[p=0.80]）。根据血管造影因素，TLR 风险与 MV 和 SB 优先技术之间存在显著的交互作用。当 MV 直径狭窄≥70%（p 交互=0.04）、MV 比 SB 更严重狭窄（p 交互=0.008）或 MV 病变长度≥18 mm（p 交互=0.01）时，MV 优先组患者的 TLR 风险较低。
接受 MV 或 SB 优先双支架技术治疗的患者临床结局相似。使用“更严重病变优先”的双支架技术可能提供有利的预后。
