Chen En, Cai Wei, Zhang Linlin, Fan Lin, Chen Zhaoyang, Luo Yukun, Zheng Xingchun, Lin Chaogui, Peng Yafei, Chen Lianglong
Department of Cardiology, Fujian Heart Medical Center, Fujian Medical University Union Hospital, Fujian Institute of Coronary Artery Disease, Fujian Institute of Geriatrics, 350001 Fuzhou, Fujian, China.
Rev Cardiovasc Med. 2022 May 25;23(6):186. doi: 10.31083/j.rcm2306186. eCollection 2022 Jun.
A simple stenting strategy with provisional side-branch (SB) stenting or crossover stenting has been recommended as the default approach for most coronary bifurcation lesions (CBLs). The proximal optimization technique (POT) and POT-associated techniques (POTAs) were introduced to optimize the ostium of SB. However, these techniques are unable to remove the jailed struts or completely diminish vessel damage. In this study we developed a novel branch ostial optimization technique (BOOT) and assessed its efficacy and safety by a propensity score matching comparison (PSM) with POT-associated techniques (POTA).
From June 2016 to March 2018, a total of 203 consecutive patients with true CBLs were treated with BOOT (50 patients) or POTA stenting (153 patients). We performed PSM to correct for confounders from clinical and lesion characteristics. The primary endpoint was cumulative major adverse cardiac events (MACE) at 12 months including cardiac death, non-fatal myocardial infarction, and target vessel/lesion revascularization (TVR/TLR) or target vessel/lesion thrombosis (ST).
After PSM, there were 43 patients in each group. Follow-up coronary angiography was performed in 77 (89.5%) patients. At 12 months, the angiographic restenosis rate was significantly different between the BOOT group and the POTA group after PSM (proximal main branch: 20.01 11.33% vs. 26.81 14.02%, = 0.003; distal main branch: 18.07 3.71% vs. 23.44 10.78%, = 0.006; side branch: 23.53 10.12% vs. 39.01 10.29%, 0.001, respectively). The incidence of MACE at 12 months was not different between the BOOT group before PSM (8.0% vs. 11.8%, = 0.604), but less frequent after PSM (4.7% vs. 23.3%, = 0.026) when compared with the POTA group, mainly due to TVR/TLR (2.3% vs. 20.9%, = 0.015).
In patients with CBLs, BOOT is feasible for optimization of the SB ostium and may be superior to POTAs in terms of the angiographic measurements and long-term clinical outcomes at 12 months follow-up.
对于大多数冠状动脉分叉病变（CBL），推荐采用临时边支（SB）支架置入或交叉支架置入的简单支架置入策略作为默认方法。引入近端优化技术（POT）和与POT相关的技术（POTA）以优化SB的开口处。然而，这些技术无法移除被卡压的支架小梁或完全减轻血管损伤。在本研究中，我们开发了一种新型分支开口优化技术（BOOT），并通过倾向评分匹配比较（PSM）与POT相关技术（POTA）评估其有效性和安全性。
2016年6月至2018年3月，共有203例连续性真性CBL患者接受了BOOT治疗（50例）或POTA支架置入治疗（153例）。我们进行PSM以校正临床和病变特征的混杂因素。主要终点是12个月时的累积主要不良心脏事件（MACE），包括心源性死亡、非致死性心肌梗死、靶血管/病变血运重建（TVR/TLR）或靶血管/病变血栓形成（ST）。
PSM后，每组各有43例患者。77例（89.5%）患者接受了随访冠状动脉造影。12个月时，PSM后BOOT组与POTA组的血管造影再狭窄率有显著差异（近端主支：20.01±11.33%对26.81±14.02%，P = 0.003；远端主支：18.07±3.71%对23.44±10.78%，P = 0.006；边支：23.53±10.12%对39.01±10.29%，P均＜0.001）。PSM前BOOT组12个月时的MACE发生率与POTA组无差异（8.0%对11.8%，P = 0.604），但PSM后与POTA组相比发生率更低（4.7%对23.3%，P = 0.026），主要是由于TVR/TLR（2.3%对20.9%，P = 0.015）。
在CBL患者中，BOOT对于优化SB开口处是可行的，并且在12个月随访时的血管造影测量和长期临床结局方面可能优于POTA。
Zotero 插件
