双吻挤压术与裤裙式支架术用于分叉病变经皮冠状动脉介入治疗：来自PROGRESS-BIFURCATION注册研究的见解

Double kissing crush versus culotte for bifurcation percutaneous coronary interventions: insights from the PROGRESS-BIFURCATION registry.

作者信息

Mutlu Deniz, Strepkos Dimitrios, Carvalho Pedro E, Alexandrou Michaella, Ser Ozgur Selim, Kultursay Barkin, Karagoz Ali, Krestyaninov Oleg, Khelimskii Dmitrii, Uluganyan Mahmut, Soylu Korhan, Yildirim Ufuk, Uzel Seda Tanyeri, Mastrodemos Olga, Rangan Bavana V, Jalli Sandeep, Voudris Konstantinos, Sandoval Yader, Burke M Nicholas, Brilakis Emmanouil S

机构信息

Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.

Kartal Kosuyolu Postgraduate Training and Research Hospital, Istanbul, Turkey.

出版信息

J Invasive Cardiol. 2025 Jun;37(6). doi: 10.25270/jic/24.00350.

DOI:10.25270/jic/24.00350

PMID:39808459

Abstract

BACKGROUND

Upfront 2-stent techniques are often used in bifurcation percutaneous coronary interventions (PCI), but there is controversy about optimal strategy selection.

METHODS

The authors examined the clinical and angiographic characteristics and long-term outcomes of 232 bifurcation PCIs that were performed using the double kissing (DK) crush or culotte technique in 216 patients between 2014 and 2023 using data from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (NCT05100992). The inverse probability of treatment weighted (IPTW) Cox proportional hazards model was used to assess long-term outcomes.

RESULTS

DK crush was more commonly used (69.0%). Patients in the DK-crush group had similar baseline characteristics to those in the culotte group. Lesions treated with DK crush were more likely to be in the left main coronary artery (42.9% vs 15.5%, P less than .001), had larger proximal (3.50 [3.50-4.00] vs 3.50 [3.21-3.79] mm, P = .027) and distal (3.00 [3.00-3.50] vs 3.00 [2.75-3.25] mm, P = .047) main vessel diameter, and were more likely to have severe calcification (29.8% vs 5.6%, P less than .001). Technical (98.8% vs 97.2%, P = .588), procedural success (96.5% vs 95.1%, P = .698), and in-hospital major adverse cardiovascular events (MACE) (6.1% vs 3.0%, P = .509) were similar in both groups. During a median follow-up of 43 months, 60 (33.9%) patients experienced MACE. On IPTW adjusted Cox analysis, DK crush was associated with lower follow-up MACE (hazard ratio 0.28; 95% CI, 0.13-0.60; P = .001) compared with culotte driven by lower target vessel revascularization (TVR) (14.3% vs 29.3%, P = .029).

CONCLUSIONS

Compared with culotte, DK crush is associated with similar periprocedural outcomes but lower TVR and MACE during follow-up.

摘要

背景

在分叉病变经皮冠状动脉介入治疗（PCI）中，初始双支架技术经常被使用，但在最佳策略选择方面存在争议。

方法

作者使用前瞻性全球分叉病变介入治疗研究注册库（NCT05100992）的数据，研究了2014年至2023年间216例患者中采用双吻（DK）挤压或裤裙技术进行的232例分叉病变PCI的临床和血管造影特征及长期结局。采用治疗加权逆概率（IPTW）Cox比例风险模型评估长期结局。

结果

DK挤压技术使用更为普遍（69.0%）。DK挤压组患者的基线特征与裤裙组相似。DK挤压技术治疗的病变更可能位于左主干冠状动脉（42.9%对15.5%，P＜0.001），近端（3.50[3.50 - 4.00]对3.50[3.21 - 3.79]mm，P = 0.027）和远端（3.00[3.00 - 3.50]对3.00[2.75 - 3.25]mm，P = 0.047）主血管直径更大，且更可能有严重钙化（29.8%对5.6%，P＜0.001）。两组的技术成功率（98.8%对97.2%，P = 0.588）、手术成功率（96.5%对95.1%，P = 0.698）和院内主要不良心血管事件（MACE）发生率（6.1%对3.0%，P = 0.509）相似。在中位随访43个月期间，60例（33.9%）患者发生MACE。在IPTW调整的Cox分析中，与裤裙技术相比，DK挤压技术与较低的随访MACE相关（风险比0.28；95%CI，0.13 - 0.60；P = 0.001），这是由较低的靶血管血运重建（TVR）率驱动的（14.3%对29.3%，P = 0.029）。