Department of Cardiology, Fujian Medical University Union Hospital, 350001 Fuzhou, Fujian, China.
Fujian Institute of Coronary Artery Disease, 350001 Fuzhou, Fujian, China.
Rev Cardiovasc Med. 2021 Sep 24;22(3):931-938. doi: 10.31083/j.rcm2203101.
Tapered coronary artery lesions (TCALs) are often seen clinically, optimal stenting of TCALs remains challengeable. This study sought to compare clinical outcomes between the modified single stenting (MSS) and conventional overlapped stenting (COS) in treatment of TCALs. 150 patients were treated with MSS (MSS group), another 150 patients were matched with propensity score matching from 5055 patients treated with COS (COS group). Quantitative coronary angiography was performed to measure minimal lumen diameter (MLD), late lumen loss (LLL). The primary endpoint was immediate angiographic success, one-year cumulative major cardiac adverse events (MACEs) composing cardiac death, target vessel myocardial infarction (TVMI), target lesion/vessel revascularization (TLR/TVR) or stent thrombosis (ST). Post-procedural in-stent MLD (2.96 ± 0.34 versus 3.08 ± 0.33, = 0.004) was smaller and diameter stenosis (11.7 ± 4.0% versus 9.0 ± 4.8%, = 0.003) was higher in MSS group than COS group. At 1-year follow-up, in-stent MLD (2.76 ± 0.38 mm versus 2.65 ± 0.60 mm, = 0.003) was reduced, LLL (0.20 ± 0.26 mm versus 0.42 ± 0.48 mm, = 0.001), diameter stenosis (24.02 ± 20.94% versus 19.68 ± 11.75%, = 0.028) and binary restenosis (18.7% versus 10.0%, = 0.047) were increased in COS group. Angiographic success (96.7% versus 98.0%, = 0.723) was similar between MSS group and COS group. At 1-year, the cumulative MACEs (12.0% versus 22.7%, = 0.022) and TLR/TVR (10.0% versus 18.7%, = 0.047) were reduced in MSS group as compared to COS group, there was no difference in cardiac death, TVMI and ST between the groups. Compared to conventional overlapped stenting, modified single stenting for TCALs is associated with similar angiographic success, fewer one-year cumulative MACEs and less treatment cost.
冠状动脉锥形病变（TCAL）在临床上较为常见，但其最佳支架置入仍然具有挑战性。本研究旨在比较改良单支架置入术（MSS）与传统重叠支架置入术（COS）治疗 TCAL 的临床效果。150 例患者接受 MSS 治疗（MSS 组），另 150 例患者按倾向评分匹配法从 5055 例接受 COS 治疗的患者中匹配（COS 组）。采用定量冠状动脉造影术测量最小管腔直径（MLD）、晚期管腔丢失（LLL）。主要终点为即刻血管造影成功，1 年累积主要不良心脏事件（MACEs）包括心脏死亡、靶血管心肌梗死（TVMI）、靶病变/血管血运重建（TLR/TVR）或支架血栓形成（ST）。术后支架内 MLD（2.96±0.34 与 3.08±0.33， = 0.004）较小，支架内直径狭窄（11.7±4.0%与 9.0±4.8%， = 0.003）较高。在 1 年随访时，支架内 MLD（2.76±0.38mm 与 2.65±0.60mm， = 0.003）降低，LLL（0.20±0.26mm 与 0.42±0.48mm， = 0.001）、直径狭窄（24.02±20.94%与 19.68±11.75%， = 0.028）和再狭窄（18.7%与 10.0%， = 0.047）增加。MSS 组与 COS 组之间的血管造影成功率（96.7%与 98.0%， = 0.723）相似。1 年时，MSS 组的累积 MACEs（12.0%与 22.7%， = 0.022）和 TLR/TVR（10.0%与 18.7%， = 0.047）降低，与 COS 组相比，心脏死亡、TVMI 和 ST 发生率无差异。与传统重叠支架置入术相比，改良单支架置入术治疗 TCAL 具有相似的血管造影成功率，1 年累积 MACEs 发生率较低，治疗费用较低。
