Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Republic of Korea.
Division of Cardiology Department of Internal Medicine Chonnam National University Hospital Gwangju Republic of Korea.
J Am Heart Assoc. 2021 Sep 21;10(18):e021632. doi: 10.1161/JAHA.121.021632. Epub 2021 Sep 13.
Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10-year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10-year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient-oriented composite outcome (a composite of all-cause death, myocardial infarction, and any revascularization). During the 10-year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all <0.001). The risk of target vessel failure or patient-oriented composite outcome decreased continuously from 2004 to 2015 (target vessel failure: from 12.3% to 6.9%, log-rank <0.001; patient-oriented composite outcome: from 13.6% to 9.3%, log-rank <0.001). The use of a second-generation drug-eluting stent and decreased target vessel failure risk in true bifurcation lesions were the major contributors to improved patient prognosis (interaction values were <0.001 and 0.013, respectively). Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01642992 and NCT03068494.
尽管器械和技术取得了进步，但冠状动脉分叉病变仍然是经皮冠状动脉介入治疗（PCI）领域极具挑战性的病变亚组。我们评估了 10 年来分叉 PCI 的趋势及其对患者结局的影响。
我们利用 2004 年至 2015 年期间接受分叉 PCI 的 5498 例患者的数据，分析了 10 年来患者/病变特征、器械、PCI 策略、支架优化技术和临床结局的趋势。在指数手术后 2 年评估了靶血管失败（包括心源性死亡、心肌梗死和靶血管血运重建）和患者导向复合结局（包括全因死亡、心肌梗死和任何血运重建）的临床结局。在 10 年的研究期间，患者和病变的复杂性（如多血管疾病、糖尿病、慢性肾脏病和左主干分叉）不断增加（均<0.001）。从 2004 年到 2015 年，靶血管失败或患者导向复合结局的风险不断降低（靶血管失败：从 12.3%降至 6.9%，对数秩检验<0.001；患者导向复合结局：从 13.6%降至 9.3%，对数秩检验<0.001）。第二代药物洗脱支架的应用和真性分叉病变中靶血管失败风险的降低是改善患者预后的主要原因（交互值分别为<0.001 和 0.013）。
在过去 10 年的分叉 PCI 中，患者和病变特征、器械、PCI 技术和患者预后都发生了显著变化。尽管患者和病变的复杂性增加，但分叉 PCI 后的临床结局得到了改善，这主要是由于更好的器械和更广泛地采用了操作优化技术和适当的治疗策略。
https://www.clinicaltrials.gov；唯一标识符：NCT01642992 和 NCT03068494。
