血管分叉角度对冠状动脉分叉病变介入治疗中分支血管闭塞的影响

Impact of Bifurcation Angle on Side Branch Occlusion During Coronary Bifurcation Intervention in Relevant Patients

目的：探讨在冠状动脉分叉病变经皮冠状动脉介入治疗（PCI）中，血管分叉角度对分支血管闭塞的影响。方法：连续入选1171例接受分叉病变行PCI的患者（1200处分叉病变）。所有分叉角度的中位数为52°，以此为界分为低角度组（587例，600处分叉病变）和高角度组（584例，600处分又病变）两组。分支血管闭塞是指PCI术后分支血流消失或心肌梗死溶栓治疗临床试验（TIMI）血流分级下降。分析两组患者分支血管的闭塞率，并通过多因素Logistic回归分析评价血管分叉角度对分支血管闭塞在介入治疗后的影响。结果：入选的1200处分叉病变中，在PCI后共有88例病变出现分支血管闭塞（发生率为7．33％）。分支血管闭塞在高角度组的发生率明显高于低角度组（10．5％vs4．2％，P〈0．001）。多因素Logistic回归分析结果显示血管分叉角度大是分支血管闭塞的独立预测因素（比值比=1．026，95％可信区间：1．014～1．037，P〈0．01）。结论：血管分叉角度大是主支血管支架置入后分支血管闭塞的独立预测因素。分叉角度大的分支血管闭塞风险不能被忽视。

Objective： To investigate the impact of bifurcation angle （BA） on side branch occlusion （SBO） during percutaneous coronary intervention （PCI） in relevant patients. Methods： A total of 1171 consecutive patients with 1200 bifurcation lesions who received one stent technique were studied. Based on the median BA of 52°, the patients were divided into 2 groups： Low angle group, n=587 patients with 600 bifurcation lesions and High angle group, n=584 patients with 600 bifurcation lesions. SBO was defined by either side branch blood flow disappeared or TIMI grade decreased after PCI. The occurrence rate of SBO was investigated and the impact of BA on SBO during PCI was evaluated by multivariate Logistic regression analysis. Results： SBO occurred in 88/1200 （7.33%） bifurcation lesions. The occurrence rate of SBO in High angle group was igher than Low angle group （10.5% vs 4.2%, P〈0.001）. Multivariable Logistic regression analysis showed that high angle was the independent predictor of SBO occurrence （OR=1.026, 95% CI 1.014-1.037, P〈0.01）. Conclusion： High BA was an independent predictor of SBO after the main vessel stent implantation, which should not be ignored in clinical practice.