冠状动脉分叉病变不同介入治疗策略的效果评价

Analysis on clinical outcomes of treating coronary artery bifurcation lesions with different treatment strategies

目的探讨不同介入治疗策略对冠状动脉分叉病变的治疗效果。方法根据冠状动脉造影的结果将90例冠心病分叉病变患者分为A、B、C组,每组30例。A组边支直径<2.5mm,B、C组边支直径>2.5mm。三组均行介入治疗,A组术中采取边支导丝保护,B组行边支球囊扩张,C组行边支球囊扩张后植入支架(TAP技术)。比较各组术后即刻效果,随访1年,记录心绞痛、心肌梗死等主要心脏不良事件(MACE)发生情况。部分患者术后6个月行冠状动脉造影检查。结果不同的介入治疗策略对冠心病分叉病变患者的即刻效果有差异(P<0.05),其中TAP技术的即刻心绞痛发生率明显减少,且手术安全性高;随访1年三组MACE发生率无明显差异。结论 TAP技术治疗冠状动脉分叉病变短期疗效佳,长期疗效与其他治疗策略无明显差异,有待进一步临床观察。

Objective To analyze the clinical outcomes of treating coronary artery bifurcation lesions with different tech- niques. Methods According to the results of coronary angiography, 90 patients with bifurcation lesions were recruited and divided into three groups, 30 in each group. The side branch diameter in group A was less than 2.5mm, while in group B and C, the sidebranch diameter was more than 2.5mm. The three groups underwent interventional treatment; side branches of group A were treated with protective wire, balloon dilatation was performed in group B, group C was treated with DES by TAP technique after being performed balloon dilatation. The immediate efficacy was compared in the three groups. After twelve months follow-up, the major adverse cardiac events （MACE） such as angina pectoris, AMI were recorded. Coronary angiog- raphy was performed in some patients after six months. Results There was significant difference among three groups in im- mediate efficacy with different treatment strategies （P 〈 0.05 ）. TAP had better curative effect, and with high safety of the operation. After twelve months follow-up, there was no significant difference in MACE among three groups. Conclusion TAP technique in the treatment of coronary bifurcation lesions was safe and had better effect on the short-term outcome, but there was no significant difference in long-term effect compared with other treatment strategies. Therefore, it needs further clinical observation.