界嵴角度对冠脉分叉病变介入治疗时分支闭塞的影响

How Carina Angle Impact the Fate of Side Branch after Main Vessel Stenting in Coronary Bifurcation Intervention

目的斑块和界嵴的移位可能是造成分支血管闭塞的主要原因。为确认界嵴移位与分支闭塞的关系,我们比较了不同界嵴角度的两组分叉病变在分支闭塞发生率方面的差别。方法和结果本研究连续入选1200例分叉病变,均采用单支架或必要时双支架策略。以中位数31°为界,将病变分为高界嵴角度和低界嵴角度两组,比较两组的分支闭塞发生率,应用多变量Logistic回归分析识别分支闭塞的独立预测因素。高界嵴角度组的分支闭塞发生率(61/597,10.2%)明显高于低界嵴角度组(27/603,4.5%)(p<0.01)。经多变量分析后证实:高界嵴角度是发生分支血管闭塞的独立预测因子(OR:1.024,95%CI:1.015-1.034,p<0.01)。结论高界嵴角度与分支闭塞发生率增高相关。既往关于低界嵴角度更易出现界嵴移位从而导致分支闭塞的假说有必要进一步探讨。

Objective Both plaque shift and carina shift have been thought to be the potential mechanism of side branch （SB） occlusion. We aimed to validate the hypothesis of carina shift by comparing the incidence of SB occlusion between coronary bifurcation lesions with low and high carina angle （CA）. Methods and Results A total of 1200 consecutive bifurcation lesions undergoing one stent or provisional two stent techniques were studied. The lesions were divided into low angle and high angle groups using the median CA （31 °）. The incidence of SB occlusion was compared between the two groups. Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion.. The rate of SB occlusion was significantly higher in the high angle group （61/597, 10.2%） than the low angle group （27/603, 4.5%） （p〈0.01）. Multivariable analysis showed that high angle was an independent predictor of SB occlusion （odds ratio： 1.024, 95% confidence intervals： 1.015-1.034, p〈0.01）. Conclusion High CA may relate with higher incidence of side branch occlusion during coronary bifurcation intervention. The hypothesis of carina shift, which considered lower CA as the major reason of side branch occlusion, warrant further validation.