根据左主干与非左主干位置及治疗策略对真性分叉病变的预后差异
Differential Prognosis of True Bifurcation Lesions According to Left Main Versus Non-Left Main Location and Treatment Strategy.
作者信息
Choi Ki Hong, Nam Chang-Wook, Bruno Francesco, Cho Yun-Kyeong, De Luca Leonardo, Kang Jeehoon, Mattesini Alessio, Song Young Bin, Truffa Alessandra, Kim Hyo-Soo, Wańha Wojciech, Chun Woo Jung, Gili Sebastiano, Helft Gerard, Han Seung Hwan, Cortese Bernardo, Lee Cheol Hyun, Escaned Javier, Yoon Hyuck-Jun, Chieffo Alaide, Hahn Joo-Yong, Gallone Guglielmo, Choi Seung-Hyuk, De Ferrari Gaetano, Koo Bon-Kwon, Quadri Giorgio, Hur Seung-Ho, D'Ascenzo Fabrizio, Gwon Hyeon-Cheol, de Filippo Ovidio
机构信息
Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea.
Division of Cardiology, Department of Internal Medicine Keimyung University Dongsan Hospital Daegu Republic of Korea.
出版信息
J Am Heart Assoc. 2025 Feb 4;14(3):e037657. doi: 10.1161/JAHA.124.037657. Epub 2025 Feb 3.
BACKGROUND
Although true bifurcation lesions are associated with a high risk of procedural complications, the differential prognostic implications of percutaneous coronary intervention for true bifurcations according to lesion location are unclear. This study aimed to identify whether clinical outcomes of true bifurcation lesions differed between left main coronary artery (LM) and non-LM bifurcations and to determine the optimal treatment strategy for subtypes of bifurcation lesions in the current-generation drug-eluting stent era.
METHODS
The ULTRA-BIFURCAT (Combined Insights From the Unified COBIS III, RAIN, and ULTRA Registries) was created by merging 3 bifurcation-dedicated registries from Korea and Italy. For this, 6548 patients treated with bifurcation lesions were stratified by lesion location and subtype. The primary end point was major adverse cardiac events (MACEs; composite of all-cause death, myocardial infarction, target lesion revascularization, and stent thrombosis) at 800 days.
RESULTS
In patients with an LM bifurcation, those with a true bifurcation had a significantly higher risk of a MACE than those with a nontrue bifurcation (20.2% versus 13.4%, adjusted hazard ratio [HR], 1.44 [95% CI, 1.11-1.86]; =0.006). Conversely, there was no significant difference in the risk of a MACE according to true versus nontrue bifurcation in patients with non-LM bifurcation lesions (9.0% versus 8.8%; adjusted HR, 1.02 [95% CI, 0.82-1.27]; =0.849). For LM true bifurcations, MACE rates were comparable between 1-stent and 2-stent strategies, whereas for LM nontrue bifurcations, the 2-stent strategy was associated with a significantly higher risk of MACEs than the 1-stent strategy. No significant differences in the risk of MACEs were observed in non-LM bifurcation lesions according to lesion subtype or treatment strategy.
CONCLUSIONS
Clinical outcomes were worse for LM true bifurcation lesions than non-LM true bifurcation lesions. A provisional 1-stent strategy should be the preferred approach for treating LM nontrue bifurcation lesions.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03068494, NCT03544294, and NCT05205148.
背景
尽管真性分叉病变与手术并发症的高风险相关，但根据病变位置，经皮冠状动脉介入治疗真性分叉病变的不同预后影响尚不清楚。本研究旨在确定左主干冠状动脉（LM）分叉病变和非LM分叉病变的真性分叉病变的临床结局是否存在差异，并确定当代药物洗脱支架时代分叉病变亚型的最佳治疗策略。
方法
通过合并来自韩国和意大利的3个分叉病变专用注册研究创建了ULTRA-BIFURCAT（统一COBIS III、RAIN和ULTRA注册研究的综合见解）。为此，将6548例接受分叉病变治疗的患者按病变位置和亚型进行分层。主要终点是800天时的主要不良心脏事件（MACE；全因死亡、心肌梗死、靶病变血运重建和支架血栓形成的复合终点）。
结果
在LM分叉病变患者中，真性分叉病变患者发生MACE的风险显著高于非真性分叉病变患者（20.2%对13.4%，调整后危险比[HR]为1.44[95%CI，1.11-1.86]；P=0.006）。相反，在非LM分叉病变患者中，根据真性与非真性分叉，发生MACE的风险没有显著差异（9.0%对8.8%；调整后HR为1.02[95%CI，0.82-1.27]；P=0.849）。对于LM真性分叉病变，单支架和双支架策略的MACE发生率相当，而对于LM非真性分叉病变，双支架策略与MACE风险显著高于单支架策略相关。在非LM分叉病变中，根据病变亚型或治疗策略，未观察到MACE风险的显著差异。
结论
LM真性分叉病变的临床结局比非LM真性分叉病变更差。临时单支架策略应是治疗LM非真性分叉病变的首选方法。
注册
网址：https://www.clinicaltrials.gov；唯一标识符：NCT03068494、NCT03544294和NCT05205148。
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