Salinas Pablo, Mejía-Rentería Hernán, Herrera-Nogueira Raúl, Jiménez-Quevedo Pilar, Nombela-Franco Luis, Núñez-Gil Iván Javier, Gonzalo Nieves, Del Trigo María, Pérez-Vizcayno María José, Quirós Alicia, Escaned Javier, Macaya Carlos, Fernández-Ortiz Antonio
Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2018 Oct;71(10):801-810. doi: 10.1016/j.rec.2017.06.022. Epub 2017 Aug 9.
We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL.
Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years.
Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43).
Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients.
我们通过比较分叉罪犯病变（BCL）与非分叉罪犯病变，评估了ST段抬高型心肌梗死患者直接经皮冠状动脉腔内血管成形术的短期和长期疗效。
采用倾向评分匹配对照组的观察性研究。在连续纳入的2746例ST段抬高型心肌梗死患者中，我们发现了274例（10%）患有BCL的患者。主要结局是一个复合终点，包括全因死亡、心肌梗死、冠状动脉旁路移植术或靶血管血运重建，分别在30天和5年时进行评估。
倾向评分匹配（1:1）后，基线特征无差异。在BCL组中，最常用的策略是对主支进行临时支架置入（84%）。与非BCL组相比，BCL组的手术在技术上更为复杂，具体表现为球囊扩张的需求更高（BCL组为71%，非BCL组为59%；P = 0.003）、手术时间更长（BCL组为70±29分钟，非BCL组为62.8±28.9分钟；P = 0.004）以及造影剂用量更多（BCL组为256.2±87.9mL，非BCL组为221.1±82.3mL；P < 0.001）。主支血管造影成功率相似（BCL组为93.4%，非BCL组为93.8%；P = 0.86）。两组的30天全因死亡率相似：BCL组为4.7%，非BCL组为5.1%；P = 0.84。在5年随访时，全因死亡（BCL组为12%，非BCL组为13%；P = 0.95）或联合事件（BCL组为22%，非BCL组为21%；P = 0.43）方面均无差异。
BCL的直接经皮冠状动脉腔内血管成形术在技术上更为复杂；然而，主支血管造影成功率相似，与非BCL患者相比，长期预后无差异。
