Cardiology Department, Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
Cardiology Department, Zagazig University, Zagazig, Sharkia, Egypt.
Clin Res Cardiol. 2024 Jul;113(7):1070-1080. doi: 10.1007/s00392-024-02461-y. Epub 2024 Jun 4.
Severely calcified coronary bifurcations complicate percutaneous coronary interventions (PCI) and often necessitate dedicated lesion preparation. We compared the outcomes of single- versus two-stent techniques for treating heavily calcified true bifurcation lesions following rotational atherectomy (RA).
Among patients receiving RA for severely calcified true bifurcations at a single center, 59 were treated with a single stent, and another 59 received two stents. We analyzed in-hospital adverse outcomes and 1-year rates of the bifurcation-oriented composite endpoint (BOCE), defined as cardiac death, target bifurcation myocardial infarction (TB-MI), or target bifurcation revascularization (TBR).
The single-stent arm was associated with more in-hospital adverse outcomes (adj. OR, 6.13; 95% CI, 1.34-28.0; p = 0.019), driven by higher peri-procedural MI rates (18.6% vs. 5.1%, p = 0.043) and more side branch compromise (13.6% vs. 0%, p = 0.006). After 1 year, both techniques had comparable 1-year BOCE (adj. HR, 0.38; 95% CI, 0.12-1.23; p = 0.106). We observed a significant interaction between the treatment technique and the presence of LM bifurcation (p interaction = 0.012), favoring single-stent technique in patients with non-LM bifurcations (HR 0.14, 95% CI 0.03-0.68; p = 0.015). Notably, the single-stent technique had lower rates of TBR (2% vs. 15%, p log-rank = 0.026) after 1 year.
Patients with severely calcified true bifurcation lesions, treated with RA followed by a single stent implantation, had more in-hospital adverse outcomes compared to those treated with two stents. However, the superior outcomes of the two-stent technique did not translate into improved long-term results. In fact, the two-stent technique was even associated with higher rates of revascularization after 1 year.
严重钙化的冠状动脉分叉病变使经皮冠状动脉介入治疗（PCI）变得复杂，往往需要专门的病变准备。我们比较了旋磨术（RA）后治疗严重钙化真性分叉病变时单支架与双支架技术的结果。
在单一中心接受 RA 治疗严重钙化真性分叉病变的患者中，59 例接受单支架治疗，另 59 例接受双支架治疗。我们分析了住院期间的不良结局和 1 年时分叉定向复合终点（BOCE）的发生率，定义为心脏死亡、靶分叉心肌梗死（TB-MI）或靶分叉血运重建（TBR）。
单支架组与更多的住院期间不良结局相关（校正比值比[OR]，6.13；95%置信区间[CI]，1.34-28.0；p=0.019），主要由围术期 MI 发生率较高（18.6% vs. 5.1%，p=0.043）和分支病变损害更常见（13.6% vs. 0%，p=0.006）所致。1 年后，两种技术的 1 年 BOCE 发生率相当（校正 HR，0.38；95%CI，0.12-1.23；p=0.106）。我们观察到治疗技术与 LM 分叉之间存在显著的交互作用（p 交互=0.012），在非 LM 分叉病变患者中，单支架技术更有利（HR 0.14，95%CI 0.03-0.68；p=0.015）。值得注意的是，1 年后单支架组 TBR 发生率较低（2% vs. 15%，log-rank p=0.026）。
接受 RA 治疗后植入单支架的严重钙化真性分叉病变患者住院期间不良结局发生率高于接受双支架治疗的患者。然而，双支架技术的优势并不能转化为更好的长期结果。事实上，双支架技术甚至与 1 年后更高的血运重建率相关。
