冠状动脉分叉病变介入治疗中小分支闭塞的发生率、预测因素及对围术期心肌梗死的影响

Investigation of Mobidity,Prognosis and the Effect of Myocardial Infacfion in Patieuts With Small Side Branch Occlusion During Coronary Bifurcation Intervention

目的:探讨冠状动脉分叉病变介入治疗中小分支闭塞导致的围术期心肌损伤的发生率及其预测因素。方法:连续入选925例经皮冠状动脉介入治疗(PCI)的患者,共包括949个分叉病变[冠状动脉造影定量分析(QCA)测量分支直径≤2.0mm],根据分叉病变是否发生了小分支闭塞分为小分支闭塞组(85例,86个分叉病变)和小分支未闭塞组(840例,863个分叉病变)。收集所有入选患者的临床特征、冠状动脉造影及PCI术中的情况、QCA的数据。采用多元回归分析来确定小分支闭塞的独立预测因素。比较小分支闭塞组和小分支未闭塞组的围术期心肌损伤的发生率。结果:949个分叉病变中共有86个(9.1%)分叉病变发生了小分支闭塞,小分支闭塞组围术期心肌损伤的发生率(26/83,313%)明显高于小分支未闭塞组(77/821,9.4%;P<0.001),围术期心肌梗死的发生率(6/83,7.2%)也显著高于小分支未闭塞组(11/821,1.3%;P<0.001)。两组间主支近段、主支远段、小分支、分叉核心的血管直径及狭窄程度差异均有统计学意义。主支/小分支直径比值小分支闭塞组明显大于小分支未闭塞组(P<0.001),差异有统计学意义。小分支闭塞的独立预测因素包括真分叉病变、斑块不规则、预扩张小分支、术前小分支心肌梗死溶栓治疗临床试验(TIMI)血流分级、术前主支远端的狭窄程度、术前分叉病变核心的狭窄程度、分叉病变角度、主支/小分支直径比值、主支支架置入前小分支狭窄程度。结论:小分支闭塞的患者围术期心肌损伤的发生率明显增高,部分病变特征与小分叉病变闭塞有关。

Objective： To investigate the prognostic factor for small side branch （SB） occlusion during coronary bifurcation intervention with the incidence rate ofperi-procedural myocardial injury （PMI） in relevant patients. Methods： A total of 925 consecutive patients who received coronary bifurcation intervention were enrolled and there were 949 SB lesions 〈 2.0 mm confirmed by quantitative coronary angiography （QCA）. The patients were divided into 2 groups： SB occlusion group, n=85, including 86 bifurcation lesions and Non-SB occlusion group, n=840, including 863 bifurcation lesions. The clinical characteristics, QCA findings and PCI procedural conditions were studied by Multivariate logistic regression analyses to explore the independent predictors of SB occlusion and to compare the incidence rate of PMI. Results： The total SB occlusion rate was 9.1% （86/949）. SB occlusion group had the higher incidence rate of PMI （26/83, 31.3%） vs （77/821, 9.4%） and peri-operative MI mortality（6/83, 7.2%） vs （11/821, 1.3%） than Non-SB occlusion group, both P〈0.001. In SB occlusion group, the diameter ratio of main vessel （MV）/SB was obviously higher than Non-SB occlusion group, P〈0.001. The independent predictors of SB occlusion included in true bifurcation lesion, irregular plaque, pre-dilation of SB, TIMI flow grade of pre-procedural SB, stenosis degrees of distal MV and bifurcation core, bifurcation angle, diameter ratioof MV/SB and the stenosis degree of SB before MV stenting. Conclusion： Coronary bifurcation lesion patients with SB occlusion had the higher risk of PMI during the interventional procedure.