Rigatelli Gianluca, Zuin Marco, Ronco Federico, Caprioglio Francesco, Cavazzini Daniele, Giatti Sara, Braggion Gabriele, Perilli Stefano, Nguyen Van Tan
Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy.
Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy.
Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):751-754. doi: 10.1016/j.carrev.2018.04.005. Epub 2018 Apr 10.
Intravascular ultrasound has been suggested to optimize stent diameter and length in Left Main (LM) procedures, but in the real-world ostial LM stenting is often accomplished with angiography only guidance. The Finet law which regulates the fractal geometry of human bifurcation has the potential to increase the accuracy of stent-sizing. To retrospectively evaluating the impact on outcomes of the addition of Finet Law to standard quantitative coronary angiography (QCA) in guiding stent selection of ostial LM stenting compared to standard angiography estimation.
We retrospectively evaluated the clinical and instrumental records of patients with isolated ostial LM disease and bypass surgery contraindications or refusal as determined by the local Heart Team who received stenting from 1 January 2012 to 1 January 2017 at Rovigo General Hospital. Patients were discrimined on the basis of the addition to QCA angiographic evaluation of the Finet-law.
Seventy-three patients (45 males, mean age 69.9 ± 10.9 years old) ostial LM stenting, 36 patients using QCA and Finet law (QCA-Finet) and 37 using standard QCA angiographic (QCA-angio) evaluation of the vessel diameter. By QCA, vessel size, mean stent diameter at implantation and after post-dilatation were clearly bigger in the QCA+ Finet than QCA-angio (4.4 ± 0.8 and 3.8 ± 0.7, p < 0.001). At a mean follow-up of 5.0 ± 0.4 years, cardiovascular mortality and cardiovascular events incidence were higher in QCA-angio compared to QCA+Finet group of patients.
Our study suggested that adding the Finet law to standard angiography estimation of the LM stent size may improve long-term outcomes.
血管内超声已被建议用于优化左主干（LM）手术中支架的直径和长度，但在现实世界中，开口处LM支架置入术通常仅在血管造影引导下完成。调节人体分叉处分形几何的菲内定律有可能提高支架尺寸确定的准确性。为了回顾性评估在开口处LM支架置入术的支架选择中，与标准血管造影估计相比，将菲内定律添加到标准定量冠状动脉造影（QCA）对结果的影响。
我们回顾性评估了2012年1月1日至2017年1月1日在罗维戈综合医院接受支架置入术的、由当地心脏团队判定为孤立性开口处LM疾病且有旁路手术禁忌症或拒绝旁路手术的患者的临床和器械记录。根据是否在QCA血管造影评估中添加菲内定律对患者进行区分。
73例患者（45例男性，平均年龄69.9±10.9岁）进行了开口处LM支架置入术，36例患者使用QCA和菲内定律（QCA - Finet），37例使用标准QCA血管造影（QCA - angio）评估血管直径。通过QCA，QCA + Finet组的血管大小、植入时和后扩张后的平均支架直径明显大于QCA - angio组（4.4±0.8和3.8±0.7，p<0.001）。平均随访5.0±0.4年时，QCA - angio组患者的心血管死亡率和心血管事件发生率高于QCA + Finet组患者。
我们的研究表明，在标准血管造影估计LM支架尺寸时添加菲内定律可能会改善长期预后。
