Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea (J.H.K.).
Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.).
Circ Cardiovasc Interv. 2024 Jan;17(1):e013006. doi: 10.1161/CIRCINTERVENTIONS.123.013006. Epub 2024 Jan 16.
We previously reported the use of minimal stent area to predict angiographic in-stent restenosis after drug-eluting stent implantation for unprotected left main (LM) disease. We aimed to evaluate the optimal minimal stent area criteria for up-front LM 2-stenting based on long-term clinical outcomes.
We identified 292 consecutive patients with LM bifurcation stenosis who were treated using the crush technique. The final minimal stent area was measured in the ostial left anterior descending artery (LAD), ostial left circumflex artery (LCX), and distal LM. The primary outcome was 5-year major adverse cardiac events, including all-cause death, myocardial infarction, and target lesion revascularization.
The minimal stent area cutoff values that best predicted the 5-year major adverse cardiac events were 11.8 mm for distal LM (area under the curve, 0.57; =0.15), 8.3 mm for LAD ostium (area under the curve, 0.62; =0.02), and 5.7 mm for LCX ostium (area under the curve, 0.64; =0.01). Using these criteria, the risk of 5-year major adverse cardiac events was significantly associated with stent underexpansion in the LAD ostium (hazard ratio, 3.14; [95% CI, 1.23-8.06]; =0.02) and LCX ostium (hazard ratio, 2.60 [95% CI, 1.11-6.07]; =0.03) but not in the distal LM (hazard ratio, 0.81 [95% CI, 0.34-1.91]; =0.63). Patients with stent underexpansion in both ostial LAD and LCX had a significantly higher rate of 5-year major adverse cardiac events than those with no or 1 underexpanded stent of either ostium (<0.01).
Stent underexpansion in the LAD and LCX ostium was significantly associated with long-term outcomes in patients who underwent up-front 2-stenting for LM bifurcation stenosis.
我们之前报道了使用最小支架面积来预测药物洗脱支架置入治疗无保护左主干（LM）疾病后的血管内支架再狭窄。我们旨在根据长期临床结果评估 upfront LM 双支架置入术的最佳最小支架面积标准。
我们纳入了 292 例接受 crush 技术治疗的 LM 分叉狭窄患者。在左前降支（LAD）开口、左回旋支（LCX）开口和远端 LM 处测量最终最小支架面积。主要终点是 5 年主要不良心脏事件，包括全因死亡、心肌梗死和靶病变血运重建。
最佳预测 5 年主要不良心脏事件的最小支架面积截断值为远端 LM 处 11.8mm（曲线下面积为 0.57；=0.15）、LAD 开口处 8.3mm（曲线下面积为 0.62；=0.02）和 LCX 开口处 5.7mm（曲线下面积为 0.64；=0.01）。使用这些标准，LAD 开口处（危险比，3.14；[95%置信区间，1.23-8.06]；=0.02）和 LCX 开口处（危险比，2.60 [95%置信区间，1.11-6.07]；=0.03）支架扩张不足与 5 年主要不良心脏事件的风险显著相关，但在远端 LM 处（危险比，0.81 [95%置信区间，0.34-1.91]；=0.63）不相关。在两个开口处支架扩张不足的患者与没有或只有一个开口处支架扩张不足的患者相比，5 年主要不良心脏事件发生率显著更高（<0.01）。
在接受 upfront LM 分叉狭窄双支架置入术的患者中，LAD 和 LCX 开口处支架扩张不足与长期结果显著相关。
