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.
JACC Cardiovasc Interv. 2023 Sep 11;16(17):2083-2093. doi: 10.1016/j.jcin.2023.06.013. Epub 2023 Aug 9.
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.
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.
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.
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).
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).
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。
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。
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）。
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）。
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）。
