Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Cardiology Department, New Tokyo Hospital, Chiba, Japan.
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Royal Brompton and Harefield hospital NHS Foundation Trust, London, United Kingdom.
Int J Cardiol. 2017 Nov 1;246:26-31. doi: 10.1016/j.ijcard.2017.03.123.
Data regarding bioresorbable vascular scaffolds (BVS) use in coronary bifurcation lesions are limited. The aim of this study was to compare mid-term clinical outcomes of all-comer patients treated with BVS versus everolimus-eluting stents (EES) for bifurcation lesions.
A total of 351 non-left-main bifurcation lesions in 323 all-comer patients were treated either with BVS (166 bifurcations in 147 patients) or EES (185 bifurcations in 176 patients). The study endpoint was propensity-score adjusted target lesion failure (TLF) defined as the composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularization.
Intravascular ultrasound and/or optical coherence tomography were more frequently utilized in the BVS group as compared to the EES one (89.8% versus 13.5%, p<0.001). In the BVS group, both predilation (97.6%) and postdilation (100%) of the main branch were performed in almost all-cases. Provisional single-stenting strategy was more frequently used in the BVS group (79.5% versus 68.1%, p=0.016). At the median follow-up of 698days, there was no significant difference in the propensity score adjusted analysis for TLF (HR: 1.19, 95% CI: 0.47 to 3.03, p=0.718). A similar result was obtained when performing propensity-score matched analysis.
BVS use for coronary bifurcation lesions in real world patients was associated with comparable TLF rates up to 2-year follow-up as compared to EES. The high incidence of intravascular imaging guidance, meticulous lesion preparation, and aggressive postdilation of BVS treated lesions may have played a role in achieving equivalence to EES.
关于生物可吸收血管支架（BVS）在冠状动脉分叉病变中应用的数据有限。本研究旨在比较全患者人群中应用 BVS 与依维莫司洗脱支架（EES）治疗分叉病变的中期临床结果。
共对 323 例全患者的 351 处非左主干分叉病变进行治疗，分别应用 BVS（147 例患者 166 处分叉病变）或 EES（176 例患者 185 处分叉病变）。研究终点是倾向性评分调整后的靶病变失败（TLF），定义为心脏死亡、靶血管心肌梗死和临床驱动的靶病变血运重建的复合终点。
与 EES 组相比，BVS 组更频繁地应用血管内超声和/或光学相干断层成像（89.8%比 13.5%，p<0.001）。在 BVS 组中，几乎所有病例均行主支预扩张（97.6%）和后扩张（100%）。BVS 组更常采用临时单支架策略（79.5%比 68.1%，p=0.016）。在中位随访 698 天的倾向性评分调整分析中，TLF 的发生率无显著差异（HR：1.19，95%CI：0.47 至 3.03，p=0.718）。进行倾向性评分匹配分析时也得到了类似的结果。
在真实世界患者中，冠状动脉分叉病变应用 BVS 与 EES 相比，2 年随访时 TLF 发生率相当。BVS 治疗病变中血管内成像指导、精心的病变准备和积极的后扩张的高发生率可能在达到与 EES 相当的结果方面发挥了作用。
