主动及被动拘禁球囊技术应用于非左主干真性冠脉分叉病变的定量血流分数评价

Comparision of active and conventional jailed balloon techniques in non-left main true coronary bifurcation lesions based on quantitative flow ratio

目的通过定量血流分数(quantitative flow ratio,QFR)比较主动拘禁球囊技术(active jailed balloon technique,A-JBT)和被动拘禁球囊技术(conventional jailed balloon technique,C-JBT)对非左主干冠脉真性分叉病变(coronary bifurcation lesion,CBL)的血运重建效果。方法连续纳入2019年5月至2020年5月于复旦大学附属中山医院心内科经冠脉造影明确为CBL,并在介入治疗中采用拘禁球囊技术的255例患者,分为主动拘禁球囊组(n=171)和被动拘禁球囊组(n=84)。比较两组患者临床特点、介入治疗特点及手术即刻效果,并利用QFR对主支及分支进行功能学评价。结果255例患者的261个病变中,前降支-对角支病变204个(78.2%),Medina 1.1.1型232个(88.9%)。两组患者术前主支血管及分支血管的病变分型、病变部位及狭窄程度相似。相较于被动拘禁球囊组,主动拘禁球囊组分支血管急性闭塞发生率明显低(0.6%vs 10.7%,P<0.001),分支血管心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流3级占比更高(96.0%vs 78.6%,P<0.001),分支血管QFR改善更显著[0.90(0.84,0.95)vs 0.83(0.68,0.91),P<0.001]。结论在非左主干冠脉真性分叉病变介入治疗中,主动拘禁球囊技术较被动拘禁球囊技术可更有效降低分支闭塞发生率,同时明显改善分支血管功能性血供。

Objective To evaluate the active jailed balloon technique(A-JBT)and conventional jailed balloon technique(C-JBT)in non-left main true coronary bifurcation lesion(CBL)using quantitative flow ratio(QFR).Methods A total of 255 patients with CBL confirmed by coronary angiography(CAG)were consecutively enrolled from Zhongshan Hospital,Fudan University between May 2019 and May 2020.The clinical characteristics,percutaneous coronary intervention(PCI)related data,immediate events after main vessel stenting as well as QFR of main vessel and side branch were compared between A-JBT group(n=171)and C-JBT group(n=84).Results There were 261 CBLs included and 204(78.2%)lesions involved left anterior descending coronary artery(LAD),232(88.9%)lesions were Medina 1.1.1.The was no significant difference in procedural details involving target lesion characteristics as well as the stenosis degrees of main vessel and side branch between two groups.After main vessel-stenting,the incidence of acute side branch occlusion in A-JBT group was significantly lower than that in C-JBT group(0.6%vs 10.7%,P<0.001).Meanwhile,the patients in A-JBT group obtained significantly higher rate of thrombolysis in myocardial infarction(TIMI)grade 3(96.0%vs 78.6%,P<0.001),and had higher QFR of side branch(0.90[0.84,0.95]vs 0.83[0.68,0.91],P<0.001)compared with C-JBT group.Conclusion In non-left main true CBL,A-JBT can reduce the incidence of acute occlusion in side branch and improve functional blood supply compared with C-JBT.