Choi Ki Hong, Song Young Bin, Jeong Jin-Ok, Park Taek Kyu, Lee Joo Myung, Yang Jeong Hoon, Hahn Joo-Yong, Choi Seung-Hyuk, Choi Jin-Ho, Lee Sang Hoon, Jeong Myung-Ho, Koo Bon-Kwon, Kim Hyo-Soo, Yu Cheol Woong, Rha Seung Woon, Jang Yangsoo, Yoon Jung Han, Oh Ju Hyeon, Park Jong-Seon, Gwon Hyeon-Cheol
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Rev Esp Cardiol (Engl Ed). 2018 Oct;71(10):811-819. doi: 10.1016/j.rec.2018.01.002. Epub 2018 Feb 21.
There are limited data on the preferred treatment strategy in ST-segment elevation myocardial infarction (STEMI) patients with bifurcation lesions. This study aimed to compare clinical outcomes between 1-stent and 2-stent strategies in STEMI patients with bifurcation lesions undergoing primary percutaneous coronary intervention (PCI).
The COronary BIfurcation Stenting II is a retrospective multicenter registry of 2897 consecutive patients with bifurcation lesions undergoing PCI with drug-eluting stents from January 2003 through December 2009. Among the registered population, 367 (12.7%) patients had STEMI; of these, a 1-stent strategy was used in 304 patients and a 2-stent strategy in 63 patients; 77.1% of the patients received primary PCI with a first-generation drug-eluting stent. The inverse-probability-of-treatment-weighting method was used to adjust for confounding factors. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis.
The median length of follow-up was 38 months. Postprocedural side branch diameter stenosis differed significantly between the 2 groups (1-stent vs 2-stent, 42.7% vs 9.7%; P < .001). After the performance of inverse-probability-of-treatment-weighting methods, the rate of MACE was significantly higher in the 2-stent group than in the 1-stent group (HR, 1.85; 95%CI, 1.19-2.87; P = .006), mainly driven by target lesion revascularization and stent thrombosis.
In STEMI patients with bifurcation culprit lesions undergoing primary PCI, the 2-stent strategy had significantly higher rates of MACE than the 1-stent strategy, despite successful treatment of the side branch. However, this result should be interpreted with caution because this study does not reflect current practice.
关于ST段抬高型心肌梗死（STEMI）合并分叉病变患者的最佳治疗策略，相关数据有限。本研究旨在比较接受直接经皮冠状动脉介入治疗（PCI）的STEMI合并分叉病变患者采用单支架和双支架策略后的临床结局。
冠状动脉分叉病变支架置入术II是一项回顾性多中心注册研究，纳入了2003年1月至2009年12月期间连续2897例接受药物洗脱支架PCI治疗的分叉病变患者。在注册人群中，367例（12.7%）患者为STEMI；其中，304例患者采用单支架策略，63例患者采用双支架策略；77.1%的患者接受了第一代药物洗脱支架的直接PCI治疗。采用治疗权重反概率法对混杂因素进行调整。主要结局为主要不良心血管事件（MACE），定义为心脏死亡、心肌梗死、靶病变血运重建和支架血栓形成的复合事件。
中位随访时间为38个月。两组术后分支血管直径狭窄程度存在显著差异（单支架组与双支架组分别为42.7%和9.7%；P < 0.001）。在采用治疗权重反概率法后，双支架组的MACE发生率显著高于单支架组（HR，1.85；95%CI，1.19 - 2.87；P = 0.006），主要由靶病变血运重建和支架血栓形成所致。
在接受直接PCI治疗的STEMI合并分叉罪犯病变患者中，尽管分支血管成功治疗，但双支架策略的MACE发生率显著高于单支架策略。然而，由于本研究未反映当前的实际情况，该结果应谨慎解读。
