Xu Yi, Xu Tian, Nong Jia-Cong, Kong Xiao-Han, Zhao Meng-Yao, Gao Zhi-Jing, Wang Yi-Fei, You Wei, Meng Pei-Na, Zhou Yu-He, Wu Xiang-Qi, Wu Zhi-Ming, Zhan Mei-En, Wang Yan-Qing, Pan De-Feng, Ye Fei
Department of Cardiology, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing Medical University, Nanjing, China.
Department of Cardiology, Clinical Medicine School of Nanjing University, Nanjing, China.
J Geriatr Cardiol. 2024 May 28;21(5):506-522. doi: 10.26599/1671-5411.2024.05.003.
To investigate whether negative remodeling (NR) detected by intravascular ultrasound (IVUS) of the side branch ostium (SBO) would affect in-stent neointimal hyperplasia (NIH) at the one-year follow-up and the clinical outcome of target lesion failure (TLF) at the long-term follow-up for patients with left main bifurcation (LMb) lesions treated with a two-stent strategy.
A total of 328 patients with de novo true complex LMb lesions who underwent a 2-stent strategy of percutaneous coronary intervention (PCI) treatment guided by IVUS were enrolled in this study. We divided the study into two phases. Of all the patients, 48 patients who had complete IVUS detection pre- and post-PCI and at the 1-year follow-up were enrolled in phase I analysis, which aimed to analyze the correlation between NR and in-stent NIH at SBO at the 1-year follow-up. If the correlation was confirmed, the cutoff value of the remodeling index (RI) for predicting NIH ≥ 50% was analyzed next. The phase II analysis focused on the incidence of TLF as the primary endpoint at the 1- to 5-year follow-up for all 328 patients by grouping based on the cutoff value of RI.
In phase I: according to the results of a binary logistic regression analysis and receiver operating characteristic (ROC) analysis, the RI cutoff value predicting percent NIH ≥ 50% was 0.85 based on the ROC curve analysis, with a sensitivity of 85.7%, a specificity of 88.3%, and an AUC of 0.893 (0.778, 1.000), = 0.002. In phase II: the TLR rate (35.8% vs. 5.3%, < 0.0001) was significantly higher in the several NR (sNR, defined as RI ≤ 0.85) group than in the non-sNR group.
The NR of LCxO is associated with more in-stent NIH post-PCI for distal LMb lesions with a 2-stent strategy, and NR with RI ≤ 0.85 is linked to percent NIH area ≥ 50% at the 1-year follow-up and more TLF at the 5-year follow-up.
探讨采用双支架策略治疗的左主干分叉（LMb）病变患者，血管内超声（IVUS）检测到的边支开口（SBO）处负性重塑（NR）是否会影响1年随访时的支架内新生内膜增生（NIH）以及长期随访时的靶病变失败（TLF）临床结局。
本研究共纳入328例接受IVUS引导下经皮冠状动脉介入治疗（PCI）双支架策略的初发真性复杂LMb病变患者。我们将研究分为两个阶段。在所有患者中，48例在PCI术前、术后及1年随访时均有完整IVUS检测结果的患者纳入I期分析，旨在分析1年随访时NR与SBO处支架内NIH的相关性。若相关性得到证实，接下来分析预测NIH≥50%的重塑指数（RI）临界值。II期分析以所有328例患者为对象，以RI临界值分组，重点关注1至5年随访时以TLF发生率作为主要终点的情况。
I期：根据二元逻辑回归分析和受试者工作特征（ROC）分析结果，基于ROC曲线分析，预测NIH百分比≥50%的RI临界值为0.85，灵敏度为85.7%，特异度为88.3%，曲线下面积（AUC）为0.893（0.778，1.000），P = 0.002。II期：在几个NR（定义为RI≤0.85）组中，靶病变血运重建（TLR）率（35.8%对5.3%，P < 0.0001）显著高于非NR组。
对于采用双支架策略治疗的远端LMb病变，左旋支开口（LCxO）处的NR与PCI术后更多的支架内NIH相关，RI≤0.85的NR与1年随访时NIH面积百分比≥50%以及5年随访时更多的TLF相关。
