Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea.
J Interv Cardiol. 2020 Jul 11;2020:2475930. doi: 10.1155/2020/2475930. eCollection 2020.
The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique.
Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI).
Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1 generation drug-eluting stent (DES), 37% 2 generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR).
In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the <152° group (35.7% vs. 14.6%; adjusted hazard ratio 3.476; 95% confidence interval 1.612-7.492). An LM-LAD angle ≥152° was an independent predictor of TLF. In the T-stenting, no bifurcation angle affected the clinical outcomes.
In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.
本研究旨在评估采用双支架技术治疗左主干（LM）分叉病变时 3 种分叉角度的临床影响。
关于经皮冠状动脉介入治疗（PCI）后 LM 分叉角度的影响，相关数据有限。
利用韩国 4 家中心的患者水平 4 项注册研究，共纳入 462 例行双支架技术治疗的 LM 分叉病变患者（181 例采用 crush 技术，167 例采用 T 支架术；63%为 1 代药物洗脱支架（DES），37%为 2 代 DES）。测量 LM 与左前降支（LAD）、LM 与左回旋支（LCX）和 LAD 与 LCX 之间的 3 个分叉角度。主要终点是靶病变失败（TLF），包括心源性死亡、心肌梗死和靶病变血运重建（TLR）。
在采用 crush 技术的患者中，预测 TLF 的最佳临界值（BCV）为 LM-LAD 角度为 152°。在 crush 组中，LM-LAD 角度≥152°组的 TLF 发生率明显高于<152°组（35.7%比 14.6%；调整后的危险比 3.476；95%置信区间 1.612-7.492），主要是由 TLR 驱动。LM-LAD 角度≥152°是 TLF 的独立预测因素。在 T 支架术组中，没有分叉角度影响临床结局。
在采用双支架技术治疗 LM 分叉病变时，宽大的 LM-LAD 角度（≥152°）与 crush 技术中 TLF 的风险增加相关，而分叉角度对 T 支架术结果没有影响。
