0.0.1 型 Medina 冠状动脉分叉病变 1- 支架与 2- 支架技术治疗效果的比较。
Comparison of Outcomes Between 1- and 2-Stent Techniques for Medina Classification 0.0.1 Coronary Bifurcation Lesions.
机构信息
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy.
出版信息
JACC Cardiovasc Interv. 2023 Sep 11;16(17):2083-2093. doi: 10.1016/j.jcin.2023.06.013. Epub 2023 Aug 9.
BACKGROUND
Although Medina 0.0.1 bifurcation lesions are often treated by percutaneous coronary intervention (PCI) in real-world practice, the optimal revascularization strategy for this lesion is uncertain.
OBJECTIVES
The current study aimed to compare the clinical outcomes between 1- and 2-stent strategies in patients treated with PCI for Medina 0.0.1 bifurcation lesions.
METHODS
The extended BIFURCAT (Combined Insights From the Unified RAIN [Very Thin Stents for Patients with Left Main or Bifurcation in Real Life] and COBIS [Coronary Bifurcation Stenting] Bifurcation Registries) registry was obtained by patient-level merging the dedicated bifurcation COBIS II, III, and RAIN registries. Among 8,434 patients with bifurcation lesions undergoing PCI, 345 (4.1%) with Medina 0.0.1 lesions were selected for the current analysis. The primary endpoint was major adverse cardiac event (MACE, a composite of all-cause death, myocardial infarction, target vessel revascularization, and stent thrombosis) at 800 days.
RESULTS
In the total population, 209 patients (60.6%) received PCI with a 1-stent strategy and the remaining 136 patients (39.4%) with a 2-stent strategy. There was a tendency for higher use of a 1-stent strategy over time (36.0%, 47.4%, and 90.4% in 2003-2009, 2010-2014, and 2015-2017, respectively; P for trend < 0.001). For the treatment of Medina 0.0.1 lesions, there was no significant difference in the risk of MACE between 1- and 2-stent strategies (1 stent vs 2 stent, 14.3% vs 13.9%; HR: 1.034; 95% CI: 0.541-1.977; P = 0.92). The risk of MACE was also not significantly different when stratifying into 3 groups (1-stent crossover only, 1-stent with strut opening, and 2-stent strategy).
CONCLUSIONS
In patients with a Medina 0.0.1 type bifurcation lesion, PCI with a 1-stent strategy showed comparable outcomes to that of a 2-stent strategy. (Coronary Bifurcation Stenting II [COBIS II]; NCT01642992; Coronary Bifurcation Stenting III [COBIS III]; NCT03068494; Very Thin Stents for Patients with Left Main or Bifurcation in Real Life [RAIN]; NCT03544294).
背景
尽管 Medina 0.0.1 分叉病变在真实世界的实践中常通过经皮冠状动脉介入治疗（PCI）进行治疗，但这种病变的最佳血运重建策略仍不确定。
目的
本研究旨在比较接受 PCI 治疗的 Medina 0.0.1 分叉病变患者中 1 支架与 2 支架策略的临床结局。
方法
通过患者水平合并专用分叉 COBIS II、III 和 RAIN 登记处，获得扩展 BIFURCAT（联合从统一 RAIN [用于真实世界中左主干或分叉病变的超薄支架]和 COBIS [冠状动脉分叉支架]分叉登记处获得的见解）登记处。在 8434 例接受 PCI 治疗的分叉病变患者中，选择 345 例（4.1%） Medina 0.0.1 病变患者进行当前分析。主要终点是 800 天的主要不良心脏事件（MACE，全因死亡、心肌梗死、靶血管血运重建和支架血栓形成的复合终点）。
结果
在总人群中，209 例（60.6%）患者接受 1 支架 PCI，136 例（39.4%）患者接受 2 支架 PCI。随着时间的推移，1 支架策略的使用率呈上升趋势（分别为 2003-2009 年的 36.0%、2010-2014 年的 47.4%和 2015-2017 年的 90.4%；趋势 P 值<0.001）。对于 Medina 0.0.1 病变的治疗，1 支架和 2 支架策略的 MACE 风险无显著差异（1 支架 vs 2 支架，14.3% vs 13.9%；HR：1.034；95%CI：0.541-1.977；P=0.92）。当分层为 3 组时，MACE 的风险也没有显著差异（仅 1 支架交叉、1 支架有支架撑开和 2 支架策略）。
结论
在 Medina 0.0.1 型分叉病变患者中，1 支架 PCI 与 2 支架策略的结果相当。（冠状动脉分叉支架 II [COBIS II]；NCT01642992；冠状动脉分叉支架 III [COBIS III]；NCT03068494；真实世界中左主干或分叉病变的超薄支架 [RAIN]；NCT03544294）。
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