单支架和双支架策略治疗冠状动脉分叉病变的临床疗效评价  

Therapeutic effect evaluation of single and double stent strategy on coronary bifurcation lesions

作　　者：孙美珠 刘宏斌[2] 黄党生[1] 于茜[2] 肖湖南 SUN Mei-zhu; LIU Hong-bin; HUANG Dang-sheng; YU Qian; XIAO Hu-nan(Department of Cardiology, First Affiliated Hospital of General Hospital of PLA, Beijing, 100048, China)

机构地区：[1]中国人民解放军总医院第一附属医院心内科,北京市100048 [2]解放军总医院南楼心血管内科

出　　处：《心血管康复医学杂志》2018年第5期541-546,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨单支架与双支架置入治疗冠状动脉分叉病变的临床疗效。方法:回顾性分析2014年1月至2016年10月于解放军总医院就诊的455例行药物洗脱支架(DES)置入治疗冠状动脉分叉病变患者的临床资料。患者被分为单支架组(235例)和双支架组(220例)。观察比较两组病变分布情况,近端、远端及分支病变特征,支架置入,术式选择,术后即刻血流,临床不良事件率等。结果:两组患者的一般资料、冠脉造影显示的病变分布,近端、远端及分支病变特征均无显著差异,P均>0.05。单支架组全部采用Cross-over技术,双支架组采用Crush术式(46.81%)、Culotte术式(37.73%)、T支架术式和V支架术式,以前两种为主。两组术后即刻主支、分支TIMI血流3级率均无显著差异,P均>0.05。住院期间,双支架组非致死性心梗发生率显著高于单支架组(7.27%比2.98%),P=0.037。随访12个月,与单支架组比较,双支架组再狭窄率(5.53%比1.36%)显著降低,非致死性心梗(2.55%比6.82%)发生率显著升高,P=0.016,0.030。结论:单支架和双支架治疗冠状动脉分叉病变疗效无显著差异,双支架组再狭窄率显著降低,但非致死性心梗率显著升高。Objective：To explore therapeutic effect of single and double stent implantation on coronary bifurcation lesions.Methods：Clinical data of 455 patients with coronary bifurcation lesions,who received drug-eluting stent（DES）implantation in General Hospital of PLA from Jan 2014 to Oct 2016,were retrospectively analyzed.According to interventional strategy,patients were divided into single stent group（n=235）and double stent group（n=220）.The lesion distribution,lesion features of proximal,distal and bifurcation,stent implantation,surgical selection,postoperative instant blood flow,clinical adverse events were observed and compared between two groups.Results：There were no significant difference in general data,lesion distribution suggested by coronary angiography,lesion feature of proximal,distal and bifurcation between two groups,P〉0.05 all.All patients used Cross-over technique in single stent group,while double stent group used Crush（46.81%）,Culotte（37.73%）,T-stent and V-stent surgery.There were no significant difference in postoperative instant TIMI blood flow grade 3 rate of main vessel and side branch between two groups,P〉0.05 both.During hospitalization,incidence rate of nonfatal myocardial infarction in double stent group was significantly higher than that of single stent group（7.27%vs.2.98%）,P=0.037.During 12-month follow-up,compared with single stent group,there was significant reduction in restenosis rate（5.53% vs.1.36%）,and significant rise in incidence rate of nonfatal myocardial infarction（2.55%vs.6.82%）in double stent group,P=0.016,0.030 respectively.Conclusion：The therapeutic effect between single and double stent implantation treating coronary bifurcation lesions is no significant,but restenosis rate of double stent group significantly reduces and incidence rate of nonfatal myocardial infarction significantly rises.

关 键 词：冠状动脉疾病 药物洗脱支架 血管成形术 气囊 冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]