单支架最终对吻球囊扩张治疗冠状动脉分叉病变效果临床研究  

Comparing the impact of final kissing balloon inflation or not on coronary artery bifurcation lesion after treatment of a single stent

作　　者：刘佳[1] 胡晶[2] 刘海伟[2] 马颖艳[2] 徐凯[2] 董海 刘莹[2] 荆全民[2] 

机构地区：[1]辽宁医学院沈阳军区总医院研究生培养基地,沈阳110001 [2]沈阳军区总医院心内科,沈阳110001

出　　处：《中国实用内科杂志》2015年第10期843-847,共5页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省自然科学基金(201101137)

摘　　要：目的比较主支单支架植入后进行最终对吻球囊扩张与未行最终对吻球囊扩张治疗主要冠状动脉分叉病变的临床疗效。方法自2010年1月至2013年6月在沈阳军区总医院心内科因心绞痛、陈旧性心肌梗死、无痛性心肌缺血行冠脉造影检查证实为冠状动脉分叉病变,并接受冠状动脉支架介入治疗的361例患者。所有患者均采用主支植入药物涂层支架的治疗策略,其中117例行最终对吻球囊扩张,244例未行最终对吻球囊扩张。比较两组患者6个月及以上主要不良心血管事件以及冠脉造影随访显现分支狭窄及支架内再狭窄的发生率。结果 6个月后随访结果显示最终对吻球囊扩张组和非最终对吻球囊扩张组的总MACE发生率无明显差别,分别为12.0%和13.9%,P=0.93;最终对吻球囊扩张组术后心肌梗死的发生率为1.7%,非最终对吻球囊扩张组则为0.8%,P=0.60,差异无统计学意义;在最终对吻球囊扩张组和非最终对吻球囊扩张组中靶血管血运重建率分别5.1%和5.7%,P=1.00;靶病变血运重建最终对吻球囊扩张组和非最终对吻球囊扩张组的发生率非别为3.4%和6.1%,P=0.33;支架内血栓形成两组的发生率均为0;全因死亡率最终对吻球囊扩张组和非最终对吻球囊扩张组的发生率非别为1.7%和0.8%,P=0.60;6个月后心绞痛CCS分级≥2级最终对吻球囊扩张组为12.8%,非最终对吻球囊扩张组为13.1%,P=1.00。6个月及以上行冠状动脉造影随访,非最终对吻球囊扩张组与最终对吻球囊扩张组的支架内再狭窄率分别为12.9%与23.4%,差异无统计学意义(P=0.15);最终对吻球囊扩张组的分支狭窄率低于非最终对吻球囊扩张组的分支狭窄率:最终对吻球囊扩张组34.0%,非最终对吻球囊扩张组55.3%(P=0.03)。结论对于冠状动脉分叉病变患者而言,植入单支架治疗后,无论是否进行最终对吻球囊扩张,其6个月及以上临床随访心脏不良事件相似,最终对吻球囊�Objectives To study the curative effect in coronary bifurcation lesion which treated by single stent with final kissing balloon inflation or not. Methods From January 2010 to June 2013, a total of 361 patients who were diagnosed unstable angina, old myocardial infarction or painless myocardial ischemia with bifurcation lesion were divided to final kissing balloon inflation （FKBI） group（n=117） and non-FKBI group（n=224） after single stenting in Shenyang Northern Hospital. The major adverse cardiac events and angiographic results follow-up were obtained at least six months later. Results Base on the 6-months foUow-up clinic outcomes, total MACE incidence were not different in both groups （FKBI 12.0% versus non-FKBI 13.9%, P=0.93）.The incidence of MI was 1.7% in FKBI and 0.8% in non-FKBI （P=0.60）. The rate of TVR in FKBI and non-FKBI were respectively 5.1% and 5.7% （P=l.00）.The rate of TLR was 3.4% in FKBI group and 6.1% in non-FKBI group（P=0.33）.Tne incidence of stent thrombosis were 0% in both groups. There are 1.7% cardiac death in FKBI group and 0.8% in non-FKBI group（P=0.60）. In FKBI group the rate of angina CCS grade I〉 2 was 12.8%, and was 13.1% in non-FKBL 132 cases underwent coronary angiography after 6 months. The rate ofrestenosis in the main vessel in two group （FKBI and non-FKBI） was 12.9% vs. 23.4% （P=0.15 ）.The side branch （re）stenosis rate was significantly lower （34.0% vs. 55.3%, P=0.03） in the FKBI group compared with non-FKBI group respectively. Conclusion The treatment of coronary bifurcation lesion, Single stenting strategy with and without FKBI were not associated with clinical outcomes. The major adverse cardiac events were no difference in both groups in six months. Side branch restenosis were only reduced in FKBI group, but the rate ofrestenosis in the main vessel was similar in two group （FKBI and non-FKBI）.

关 键 词：冠脉分叉病变 介入治疗 单支架治疗 最终对吻球囊扩张 

分 类 号：R543.3[医药卫生—心血管疾病]