Jones Johanna, Mouyis Kyriacos, Tyrlis Angelos, Rathod Krishnaraj S, Guttmann Oliver, Wragg Andrew, O'Mahony Constantinos, Mathur Anthony, Baumbach Andreas, Jones Daniel A
Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, UK.
Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, UK.
Am Heart J Plus. 2023 May 12;30:100301. doi: 10.1016/j.ahjo.2023.100301. eCollection 2023 Jun.
Drug eluting balloons (DEB) are a feasible method of rapid delivery of drug to a coronary vessel wall. Their efficacy has been established for the treatment of in-stent restenosis and small vessel disease but there is limited data for their use in bifurcation lesions.
The aim of this study was to assess the effectiveness of provisional upfront side-branch DEB use in bifurcation lesions compared to a simple balloon (POBA) or upfront 2 stent bifurcation strategy.
We conducted an observational study of 625 patients undergoing PCI to bifurcation lesions. All the patients had a DES deployed in the main vessel (MV). Decision on revascularization option for the side branch (SB) was made by the operator. The primary endpoint was target vessel failure. Secondary endpoints were target vessel myocardial infarction and all-cause mortality.
311 patients had upfront DEB to the SB whilst the remaining were treated with either DES (188) or POBA (126). Baseline characteristics were similar aside from history of previous MI, which were higher in patients treated with DES or POBA, p = 0.009 whereas patients with previous CABG were likely to undergo DEB treatment (p = 0.004). TVF was more likely to occur in the POBA group (7.5 %) compared to the DEB (3.3 %) and DES (3.3 %) groups (p = 0.0019). There was no significant difference in TV-MI (p = 0.62) or death (p = 0.98) between the groups.
This study suggests that provisional bifurcation stenting with upfront Sirolimus DEB use in the SB is an effective treatment for non-LMS bifurcation PCI.
药物洗脱球囊（DEB）是一种将药物快速输送至冠状动脉血管壁的可行方法。其在治疗支架内再狭窄和小血管疾病方面的疗效已得到证实，但在分叉病变中的应用数据有限。
本研究旨在评估与单纯球囊（POBA）或预先置入双支架的分叉病变策略相比，临时预先对边支使用DEB在分叉病变中的有效性。
我们对625例行分叉病变经皮冠状动脉介入治疗（PCI）的患者进行了一项观察性研究。所有患者均在主血管（MV）中置入了药物洗脱支架（DES）。边支（SB）的血运重建方案由术者决定。主要终点是靶血管失败。次要终点是靶血管心肌梗死和全因死亡率。
311例患者预先对SB使用了DEB，其余患者接受了DES（188例）或POBA（126例）治疗。除既往心肌梗死病史外，基线特征相似，DES或POBA治疗的患者既往心肌梗死病史更高（p = 0.009），而既往接受冠状动脉旁路移植术（CABG）的患者更可能接受DEB治疗（p = 0.004）。与DEB组（3.3%）和DES组（3.3%）相比，POBA组发生靶血管失败（TVF）的可能性更高（7.5%）（p = 0.0019）。各组之间在靶血管心肌梗死（p = 0.62）或死亡（p = 0.98）方面无显著差异。
本研究表明，在SB中临时使用西罗莫司DEB进行分叉病变支架置入术是治疗非左主干分叉病变PCI的有效方法。
