Baeza Garzón Flor, Pan Álvarez-Ossorio Manuel, Romero Moreno Miguel Ángel, Martín Palanco Vanesa, Herrera Arroyo Concepción, Suárez de Lezo Cruz Conde José
Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain.
Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain.
Rev Esp Cardiol (Engl Ed). 2018 May;71(5):344-350. doi: 10.1016/j.rec.2017.07.018. Epub 2017 Oct 31.
There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry.
Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization.
Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results.
Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.
关于冠状动脉慢性完全闭塞（CTO）情况下分叉病变的最佳策略，几乎没有证据。本研究在多中心注册研究中比较了采用临时支架置入术与双支架技术治疗CTO分叉病变患者的手术过程及中期结果。
2012年1月至2016年6月期间，4个参与中心对922例CTO进行了再通治疗。其中，238例（25.8%）存在分叉病变（侧支血管≥2mm，位于闭塞段近端、远端或闭塞段内），采用简单方法（n = 201）或复杂策略（n = 37）进行治疗。进行倾向评分匹配以消除两组之间的选择偏倚。主要不良心脏事件（MACE）包括心源性死亡、心肌梗死和临床驱动的靶病变血运重建的综合情况。
简单组和复杂组的血管造影和手术成功率相似（94.5%对97.3%；P = 0.48以及85.6%对81.1%；P = 0.49）。然而，简单方法的造影剂用量、辐射剂量和透视时间较低。随访（25个月）时，简单组的MACE发生率为8%，复杂组为10.8%（P = 0.58）。复杂组无MACE生存率有降低趋势（80.1%对69.8%；P = 0.08）。倾向分析后，两组在即刻和随访结果方面无差异。
CTO中的分叉病变可以采用与常规分叉病变类似的方法处理，对于常规分叉病变，临时支架置入术被认为是首选技术。倾向评分匹配后，简单策略和复杂策略在手术或中期临床结果方面无差异。
