Ayman Rana, Shaheen Sameh Mohamed, Sabet Sameh Saleh, Abdellatif Yasser A
Cardiology Department, Ain Shams University Hospital, Nargess 3 - Fifth Settlement, Abbassya, PO 11835, Cairo, Egypt.
Egypt Heart J. 2022 Sep 6;74(1):63. doi: 10.1186/s43044-022-00302-9.
Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a "real-world" setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals).
This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023).
LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.
左主干冠状动脉病变与大面积心肌梗死风险相关，导致高发病率和死亡率。无论是采用临时支架技术还是双支架技术，冠状动脉分叉病变的最佳治疗方法仍存在很大争议。本前瞻性观察性研究旨在调查埃及患者在艾因夏姆斯大学医院前瞻性单中心登记处“真实世界”环境中，通过经皮冠状动脉介入治疗无保护左主干冠状动脉疾病血运重建的一年临床结局。
本研究纳入了2020年5月1日至艾因夏姆斯大学医院4月底期间接受左主干病变经皮冠状动脉介入治疗的163例患者。根据预期的支架置入技术，将患者分为两组，即临时支架技术组或双支架技术组。共有142例患者接受了临时支架置入，21例患者采用双支架技术，主要是DK Crush（双球囊对吻）技术。在预期采用临时支架置入的患者中，34例患者采用了TAP技术。对患者进行随访，观察其在住院期间、30天和1年后的主要终点。临时支架置入组有6.34%的病例发生院内死亡，其中5.36%是由心血管原因导致的。临时支架置入组的总主要不良心血管和脑血管事件（MACCE）发生率为2.96%，双支架组为4.76%。总体而言，临时支架组1年时的MACCE发生率为22.31%，双支架组为30%（p值为0.57）。临时支架置入治疗的病例中有10%发生靶血管失败（TVF），双支架技术治疗的病例中有30%发生TVF（p值为0.023）。
经皮冠状动脉介入治疗左主干冠状动脉病变被认为是一种安全有益的解决方案。临时支架置入是首选方法，同时应牢记，如果分支血管需要进一步治疗，可能需要采取补救措施。血管内超声（IVUS）或血流储备分数（FFR）辅助评估可能有助于取得更好的结果，应努力提高其可行性。
