分支球囊保护策略治疗冠状动脉真性分叉病变的预后分析

Prognostic Analysis of True Bifurcation Lesions of Coronary Artery Treated by Branch Balloon Protection Strategy

目的探讨球囊保护对角支-单支架策略与双支架治疗策略对冠状动脉前降支真性分叉病变临床预后的影响。方法收集2014年1月至2016年12月徐州医科大学附属医院心内科住院且成功行冠状动脉介入治疗的冠状动脉前降支真性分叉病变的229例患者为研究对象,依据对前降支分叉部位治疗策略不同分为球囊保护对角支-单支架组(96例)和双支架组(133例)。分析两组患者的临床基线资料、病变特点及介入手术治疗情况,比较两组患者围术期并发症和术后主要不良心脑血管事件发生情况及预后。结果两组患者临床基线资料、病变特点比较差异无统计学意义(P>0.05);而单支架组术中置入支架数目、球囊使用数目、导丝使用数目、手术耗时、对比剂用量较双支架组器械使用上明显减少[(1.89±0.86)枚比(2.62±0.69)枚,(3.12±1.00)个比(3.95±1.12)个,(2.17±0.43)个比(2.53±0.65)个,(40.78±5.25)min比(49.74±5.72)min,(150.10±44.27)mL比(186.62±44.45)mL](P<0.01);围术期并发症发生率比较差异无统计学意义(P>0.05);随访中位数时间为26个月,两组安全性(心源性死亡、非致死性心肌梗死、围术期支架内血栓形成)、有效性(靶血管再次血运重建、主分支血管再狭窄)比较差异无统计学意义(P>0.05);Kaplan-Meier生存分析显示,两组不良心脑血管事件累计生存率比较差异无统计学意义(P>0.05)。结论冠状动脉前降支真性分叉病变使用球囊保护分支行单支架术在安全性及有效性上不劣于双支架术,两者远期预后差异无统计学意义,并可降低手术难度及费用,因此可优先选择。

Objective To investigate the effect of balloon protection diagonal ranch-single stent strategy and double-stent strategy on the clinical prognosis of true bifurcation lesions of the anterior descending coronary artery. Methods A total of 229 patients with true bifurcation lesions of anterior descending coronary artery were retrospectively analyzed in the study,who were admitted to the Department of Cardiology of the Affiliated Hospital of Xuzhou Medical University and successfully treated with percutaneaus coronary intervention from Jan.2014 to Dec. 2016.According to treatment strategy,they were divided into a diagonal ranch-single stent group of 96 cases and a double-stent group of 133 cases.The clinical baseline data,pathological features and interventional treatment of the two groups were analyzed.The perioperative complications and major adverse cardiovascular and cerebrovascular events and prognosis were compared between the two groups. Results The clinical baseline data and pathological features of the two groups showed no statistically significant difference（ P 〉 0.05 ）,but the number of stents implanted,the number of balloon uses,the number of guided wire used,the operation time and contrast-medium usage in the single-stent group were significantly lower than those in the double-stent group[（1.89± 0.86 ） vs （2.62±0.69）, （3.12±1.00） vs （3.95±1.12）,（2.17±0.43） vs （2.53±0.65）,（40.78±5.25） min vs （49.74±5.72） min, （150.10±44.27） mL vs （186.62±44.45） mL]（ P 〈0.01）.The incidence of perioperative complications of the two groups had no statistically significant difference（ P 〉0.05）.The median follow-up time was 26 months,and there was no significant difference in safety（cardiogenic death, non-fatal myocardial infarction, perioperative stent thrombosis） and effectiveness （target vessel revascularization,main branch restenosis） between the two groups（ P 〉0.05）. Kaplan-Meier survival analysis showed that there was no significant difference between the two groups in the cumulative survival rate of adverse cardiovascular events（ P 〉0.05）. Conclusion The balloon protection diagonal ranch-single stent strategy is not inferior to the double-stent strategy in the safety and effectiveness for the treatment of bifurcation lesions of the anterior descending branch of the coronary artery,with no statistically significant difference in long term prognosis.Furthermore it can reduce the difficulty and cost of operation,therefore,can be deemed as the preferred choice.