Liu G, Ke X, Huang Z-B, Wang L-C, Huang Z-N, Guo Y, Long M, Liao X-X
Department of Cardiology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Cardiology, Shenzhen Sun Yat-sen Cardiovascular Hospital, Shenzhen, China.
Herz. 2019 Jun;44(4):354-362. doi: 10.1007/s00059-017-4647-1. Epub 2017 Nov 27.
The efficacy of final kissing balloon (FKB) inflation in one-stent techniques for bifurcation lesions is controversial. The goal of the present study was to investigate the impact of FKB on long-term clinical outcomes in one-stent strategies.
A literature search of the PubMed, Embase, and Cochrane Library databases was undertaken through August 2017. The primary outcome was major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and target lesion revascularization. Overall hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effects model.
Ten studies comprising 7364 patients treated with a one-stent technique were included in the analysis. Overall, FKB did not demonstrate a significant reduction in MACE compared with non-FKB in both randomized trials (HR: 1.13; 95% CI: 0.65-1.98) and observational studies (HR: 0.86; 95% CI: 0.61-1.20). The risk of cardiac death (HR: 0.89; 95% CI: 0.53-1.49), myocardial infarction (HR: 0.76; 95% CI: 0.53-1.09), and target lesion revascularization (HR: 0.96; 95% CI: 0.74-1.23) was also similar in both groups.
FKB may not be mandatory and a selective FKB strategy might be more justified in one-stent techniques for bifurcation lesions.
在分叉病变的单支架技术中,最终亲吻球囊(FKB)扩张的疗效存在争议。本研究的目的是探讨FKB对单支架策略长期临床结局的影响。
通过检索截至2017年8月的PubMed、Embase和Cochrane图书馆数据库。主要结局是主要不良心脏事件(MACE),定义为心脏死亡、心肌梗死和靶病变血运重建的复合事件。采用随机效应模型计算总体风险比(HR)和95%置信区间(CI)。
分析纳入了10项研究,共7364例采用单支架技术治疗的患者。总体而言,在随机试验(HR:1.13;95%CI:0.65-1.98)和观察性研究(HR:0.86;95%CI:0.61-1.20)中,与非FKB相比,FKB均未显示出MACE有显著降低。两组的心脏死亡风险(HR:0.89;95%CI:0.53-1.49)、心肌梗死风险(HR:0.76;95%CI:0.53-1.09)和靶病变血运重建风险(HR:0.96;95%CI:0.74-1.23)也相似。
在分叉病变的单支架技术中,FKB可能并非必需,选择性FKB策略可能更合理。