不同分支球囊保护策略治疗冠状动脉分叉病变的临床效果比较

Comparison of clinical effects of different branch balloon protection strategies in the treatment of coronary bifurcation lesions

目的比较不同分支球囊保护策略在冠状动脉分叉病变患者中的临床治疗效果。方法260例冠状动脉分叉病变患者,按不同分支球囊保护策略分为单支架组和双支架组,每组130例。单支架组采用单支架分支球囊保护策略,双支架组采用双支架球囊保护策略。比较两组围术期指标、冠状动脉造影(CAG)检查结果及并发症发生情况、主要心血管不良事件(MACE)发生情况。结果单支架组手术时间(43.64±5.03)min短于双支架组的(49.83±5.37)min,球囊使用数量(3.46±0.31)个、支架植入数量(1.86±0.28)枚及导丝使用数量(2.04±0.41)个少于双支架组的(4.25±0.56)个、(2.35±0.35)枚、(2.35±0.53)个,对比剂用量(151.71±28.18)ml少于双支架组的(175.52±32.32)ml,差异有统计学意义(P<0.05)。两组主支、分支的心肌梗死溶栓实验(TIMI)血流3级比例及血管残余狭窄≥30%比例比较,差异无统计学意义(P>0.05)。两组术中分支血管慢血流、术中分支血管闭塞、术后心肌酶谱增高及术后心肌梗死发生率比较,差异无统计学意义(P>0.05)。随访6个月,单支架组MACE发生率8.46%与双支架组的7.69%比较,差异无统计学意义(P>0.05)。结论单支架与双支架分支球囊保护策略治疗冠状动脉分叉病变临床效果确切,但与双支架球囊保护策略比较,单支架球囊保护策略能减少支架、球囊、导丝使用及对比剂用量,手术时间更短,更具有优势。

Objective To compare the clinical effect of different branch balloon protection strategies in the treatment of coronary bifurcation lesions.Methods A total of 260 patients with coronary bifurcation lesions were divided into a single-stent group and a double-stent group according to different branch balloon protection strategies,with 130 cases in each group.The single-stent group adopted the single-stent branch balloon protection strategy,and the double-stent group adopted the double-stent balloon protection strategy.The perioperative indicators,results of coronary angiography(CAG),complications,and the incidence of main adverse cardiovascular events(MACE)was were compared between the two groups.Results The operating time of(43.64±5.03)min in single stent group was shorter than that of(49.83±5.37)min in double-stent group;single-stent group had the number of balloons used of(3.46±0.31)balloons,the number of stent implantation of(1.86±0.28)stents and the number of guide wire used of(2.04±0.41)guide wires,which were less than those of(4.25±0.56)balloons,(2.35±0.35)stents and(2.35±0.53)guide wires in the double-stent group;the amount of contrast agent of(151.71±28.18)ml in the single-stent group was less than that of(175.52±32.32)ml in the double-stent group;the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups when comparing the percentages of thrombolysis in myocardial infarction(TIMI)flow grade 3 and residual stenosis≥30%of the vessel in the main branch and branches(P>0.05).There was no statistically significant difference between the two groups in the comparison of intraoperative slow blood flow of branch vessels,intraoperative branch vessel occlusion,postoperative myocardial enzyme spectrum increase and postoperative incidence of myocardial infarction(P>0.05).At 6-month follow-up,the incidence of MACE was 8.46%in the single-stent group,and the difference was not statistically significant compared with that of 7.69%in the doublestent group(P>0.05).Conclusion The clinical effect of single-stent and double-stent branch balloon protection strategies in the treatment of coronary bifurcation lesions is definite,however,compared with the double-stent balloon protection strategy,the single-stent balloon protection strategy can reduce the use of stents,balloons,guide wires,and the amount of contrast agent,and the operatiing time is shorter and has more advantages.