左前降支真性分叉病变中边支处理与患者因素的相关性：GRAND-DES 注册研究的分析。

Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry.

机构信息

Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of Korea.

出版信息

J Interv Cardiol. 2020 Dec 27;2020:8858642. doi: 10.1155/2020/8858642. eCollection 2020.

METHODS

Patients undergoing PCI to left anterior descending (LAD) bifurcation lesions with contemporary DES were analyzed from a nationwide registry. Baseline risk was assessed using the Age, Creatinine, and Ejection Fraction (ACEF) score. Target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization, was assessed at 3 years.

RESULTS

Among 1,089 patients with LAD bifurcation lesions, 548 (50.3%) patients underwent SB treatment. The SB treatment group showed a nonsignificant, but numerically lower rate of 3-year TLF (6.6% vs. 9.2%, HR 0.75, 95%CI 0.44-1.28, = 0.29). In patients with low pretreatment risk (ACEF<1.22), SB treatment was associated with a lower rate of 3-year TLF (HR 0.43, 95%CI 0.19-0.96, = 0.04), while no significant difference was observed in patients with high risk (ACEF≥1.22). The difference in the low risk group was mostly driven by target lesion revascularization (HR 0.24, 95%CI 0.08-0.75, = 0.01).

CONCLUSIONS

SB treatment for LAD bifurcation lesions showed favorable long-term outcomes compared with main-branch-only intervention, especially in patients with low pretreatment risk.

方法

本研究分析了一项全国性注册研究中接受经皮冠状动脉介入治疗（PCI）的左前降支（LAD）分叉病变且使用当代 DES 的患者。使用年龄、肌酐和射血分数（ACEF）评分评估基线风险。在 3 年时评估终点事件（TLF），包括心源性死亡、靶血管心肌梗死和靶病变血运重建的复合终点。

结果

在 1089 例 LAD 分叉病变患者中，548 例（50.3%）患者接受了边支（SB）治疗。SB 治疗组 3 年 TLF 的发生率虽较低，但无统计学差异（6.6% vs. 9.2%，HR 0.75，95%CI 0.44-1.28， = 0.29）。在低预处理风险（ACEF<1.22）患者中，SB 治疗与较低的 3 年 TLF 发生率相关（HR 0.43，95%CI 0.19-0.96， = 0.04），而在高风险患者（ACEF≥1.22）中未观察到显著差异。低风险组的差异主要归因于靶病变血运重建（HR 0.24，95%CI 0.08-0.75， = 0.01）。