Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Suedring 15, 79189, Bad Krozingen, Germany.
Clin Res Cardiol. 2019 Feb;108(2):175-184. doi: 10.1007/s00392-018-1337-9. Epub 2018 Jul 26.
Percutaneous coronary intervention (PCI) of unprotected distal left main stenosis (UDLM) is increasingly performed as an alternative to surgical treatment. The optimal strategy for stenting in this setting is still a matter of debate. Therefore, this analysis investigated the long-term clinical outcome of a single- versus a double-stenting strategy for treatment of UDLM.
From a large registry, 867 consecutive patients with UDLM undergoing either single or double stenting with drug-eluting stents (DES) were identified. Follow-up was up to 10 (median 3.1, interquartile range 1.1-5.3) years. Primary endpoint was MACE consisting of all-cause death, myocardial infarction, or target lesion re-intervention (TLR). Secondary clinical endpoints included these single endpoints and stent thrombosis. MACE occurred in 41.5% after single and in 49.0% after double stenting (P = 0.03). TLR was lower after single (17.4%) as compared to double stenting (27.2%; P < 0.01). Between single and double stenting, there were no significant differences for death (26.4 versus 23.3%; P = 0.31), death or myocardial infarction (29.1 versus 27.2%; P = 0.55), or definite/probable stent thrombosis (1.3 versus 2.1%; P = 0.42).
Compared with single stenting, double stenting was associated with a significantly higher long-term risk of MACE. This was driven by a higher incidence of TLR, whereas the risk of death, MI, or stent thrombosis was similar between the two strategies.
经皮冠状动脉介入治疗（PCI）治疗无保护左主干远端狭窄（UDLM）的应用越来越多，目前已成为一种替代外科治疗的方法。在这种情况下，支架置入的最佳策略仍存在争议。因此，本分析研究了在这种情况下，单支架与双支架策略治疗 UDLM 的长期临床结果。
从一个大型注册中心中，确定了 867 例连续接受药物洗脱支架（DES）单支架或双支架置入治疗的 UDLM 患者。随访时间最长达 10 年（中位数 3.1 年，四分位距 1.1-5.3 年）。主要终点是由全因死亡、心肌梗死或靶病变血运重建（TLR）组成的 MACE。次要临床终点包括这些单一终点和支架血栓形成。单支架组 MACE 发生率为 41.5%，双支架组为 49.0%（P=0.03）。单支架组 TLR 发生率（17.4%）低于双支架组（27.2%；P<0.01）。与双支架相比，单支架组的死亡率（26.4%比 23.3%；P=0.31）、死亡或心肌梗死（29.1%比 27.2%；P=0.55）或明确/可能的支架血栓形成（1.3%比 2.1%；P=0.42）无显著差异。
与单支架相比，双支架治疗与更高的长期 MACE 风险相关。这主要是由于 TLR 发生率较高所致，而两种策略之间的死亡率、心肌梗死或支架血栓形成风险相似。
