非保护真左主干分叉病变中即刻 vs. 择期双支架策略：来自 FAILS-2 亚组研究的见解。

Provisional versus elective two-stent strategy for unprotected true left main bifurcation lesions: Insights from a FAILS-2 sub-study.

机构信息

IRCCS Ospedale San Raffaele, Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy; New Tokyo Hospital, Matsudo, Japan.

IRCCS Ospedale San Raffaele, Milan, Italy.

出版信息

Int J Cardiol. 2018 Jan 1;250:80-85. doi: 10.1016/j.ijcard.2017.09.207. Epub 2017 Oct 4.

DOI:10.1016/j.ijcard.2017.09.207

PMID:28992999

Abstract

BACKGROUND

This study sought to investigate the optimal percutaneous coronary intervention (PCI) strategy for true unprotected left main coronary artery (ULMCA) bifurcations.

METHODS

The FAILS-2 was a retrospective multi-center study including patients with ULMCA disease treated with second-generation drug-eluting stents. Of these, we compared clinical outcomes of a provisional strategy (PS; n=216) versus an elective two-stent strategy (E2S; n=161) for true ULMCA bifurcations. The primary endpoint was the incidence of major adverse cardiac events (MACEs) at 3-years. We further performed propensity-score adjustment for clinical outcomes.

RESULTS

There were no significant differences between the groups in terms of patient and lesion characteristics. 9.7% of patients in the PS group crossed over to a provisional two-stent strategy. MACEs were not significantly different between groups (MACE at 3-year; PS 28.1% vs. E2S 28.9%, adjusted p=0.99). The rates of target lesion revascularization (TLR) on the circumflex artery (LCX) were numerically high in the E2S group (LCX-TLR at 3-years; PS 11.8% vs. E2S 16.6%, adjusted p=0.51).

CONCLUSIONS

E2S was associated with a comparable MACE rate to PS for true ULMCA bifurcations. The rates of LCX-TLR tended to be higher in the E2S group although there was no statistical significance.

CONDENSED ABSTRACT

This study sought to compare the clinical outcomes of a provisional strategy (PS) with an elective two-stent strategy (E2S) for the treatment of true unprotected left main coronary artery bifurcations. 377 Patients (PS 216 vs. E2S 161 patients) were evaluated, and 9.7% in the PS group crossed over to a two-stent strategy. E2S was associated with a similar major adverse cardiac event rate at 3-years when compared to the PS strategy (PS 28.1% vs. E2S 28.9%, p=0.99). However, the left circumflex artery TLR rate at 3-year tended to be higher in the E2S group (PS 11.8% vs. E2S 16.6%, p=0.51).

摘要

背景

本研究旨在探讨真性无保护左主干冠状动脉（ULMCA）分叉病变的最佳经皮冠状动脉介入（PCI）策略。

方法

FAILS-2 是一项回顾性多中心研究，纳入了接受第二代药物洗脱支架治疗的 ULMCA 疾病患者。在这些患者中，我们比较了真性 ULMCA 分叉病变采用临时策略（PS；n=216）与选择性双支架策略（E2S；n=161）的临床结局。主要终点是 3 年时主要不良心脏事件（MACEs）的发生率。我们进一步进行了倾向评分调整以评估临床结局。

结果

两组患者在患者和病变特征方面无显著差异。PS 组有 9.7%的患者交叉至临时双支架策略。两组之间 MACE 无显著差异（3 年时 MACE：PS 28.1% vs. E2S 28.9%，调整后 p=0.99）。E2S 组回旋支（LCX）靶病变血运重建（TLR）的发生率较高（3 年时 LCX-TLR：PS 11.8% vs. E2S 16.6%，调整后 p=0.51）。