冠状动脉分叉病变主支单支架术后最终球囊对吻扩张与否对临床预后的影响  

Comparison of final kissing balloon dilatation versus no-final kissing balloon dilatation in coronary bifurcation lesions treated with main vessel stenting

作　　者：郭永喆 郑行春[1] 吴佳易[1] GUO Yongze;ZHENG Xingchun;WU Jiayi(Department of Cardiology,Fujian Medical University Union Hospital,Fuzhou,350108, China)

机构地区：[1]福建医科大学附属协和医院心内科,福州350108

出　　处：《临床心血管病杂志》2018年第12期1193-1200,共8页Journal of Clinical Cardiology

基　　金：福建医科大学苗圃科研基金(No:2015MP015)

摘　　要：目的:对比研究主支支架植入术后最终球囊对吻扩张与否对患者临床预后的影响。方法:本研究系非盲、回顾性、单中心研究。对象是2009-01-2017-06福建医科大学附属协和医院的155例冠状动脉(冠脉)分叉病变患者,所有患者均采用单支架治疗策略,其中53例行最终球囊对吻扩张(对吻组),102例未行最终球囊对吻扩张(非对吻组)。结果:一级终点是术后6个月的主要心血管不良事件(MACE)。结果两组MACE的发生率没有明显差异(对吻组5.7%,非对吻组5.9%;风险比为0.98[95%可信区间:0.24～3.90],P=0.97)。术后9～12个月,127例接受了造影随访检查,两组患者随访的总体再狭窄率(包括主支和分支)类似(16.7%∶28.2%,P=0.15);对吻组主支再狭窄率2.4%,非对吻组3.5%(P=1.00);分支再狭窄率对吻组为16.7%,非对吻组27.0%(P=0.20)。并且两组的真性分叉病变病例的分支再狭窄率分别为19.4%和22.4%(P=0.72)。但是在手术时间、造影时间和造影剂用量上对吻组明显超过非对吻组(P<0.01)。进一步分析显示,非对吻组的单球囊扩张(经主支支架的分支开口扩张)可以将分支再狭窄比例从27.0%降低到10.0%,并且与双球囊组(即对吻组)对比(10.0%∶16.7%),二者间差异没有统计学意义(P=0.97)。结论:在冠脉分叉病变患者中,主支血管支架植入术后无论有无最终球囊对吻扩张,其临床随访结果相似,造影随访结果对吻组分支再狭窄率低于非对吻组,但非对吻组在手术时间、造影时间和造影剂用量上明显占优。两组中真性冠脉分叉病变患者的临床及造影随访结果亦相同。Objective:To compared clinical outcome of final kissing balloon dilatation (FKBD)versus no-Final kissing balloon dilatation (NFKBD)in coronary bifurcation lesions after primary stent implantation.Method:This was a nonblinded,retrospective,single-center study.From January 2009 to June 2018,155 patients with coronary bifurcation lesions in Fujian Union Hospital underwent MV stenting were enrolled in this study.Of which 53 patients (FKBD)received the final kissing balloon and 102 patients (NFKBD) did not.Result:The primary endpoint was the major adverse cardiac events (MACE)after 6 months post surgery.There were no significant differences in rates of MACE between the groups (N=155,FKBD 5.7%,versus NFKBD 5.9%;hazard ratio 0.98[95%confidence interval 0.24 to 3.90],P=0.97).From 9 months to 12 months after procedure,the rate of binary restenosis in the entire bifurcation lesion (MV and SB)was 16.7%versus 28.2% (P=0.15),in the MV was 2.4%versus 3.5% (P=1.00),and in the SB was 16.7% versus 27.0% (P=0.20)in FKBD versus NFKBD group,respectively.What`s more,in patients with true bifurcation,the SB restenosis rate was 19.4% versus 22.4%in FKBD and NFKBD group (P=0.72).However,longer procedure and fluoroscopy times,more x-ray dose favored the former strategy.Further analysis revealed that single balloon dilatation (SB dilatation through MV stent)in NFKBD group could reduce the SB restenosis rate from 27.0%to 10.0%.It also showed that single balloon dilatation took no advantage over the double balloon dilatation (FKBD)in angiographic SB restenosis (10.0%versus 16.7%;P=0.97).Conclusion:The clinical outcomes are similar in MV stenting with or without FKBD.Neither in clinical nor in angiographic follow-up,kissing balloon dilatation is not superior to single balloon dilatation.

关 键 词：冠脉分叉病变 单支架置入术 最终球囊对吻扩张 

分 类 号：R541.4[医药卫生—心血管疾病]