边支斑块主动转移技术治疗冠状动脉分叉病变的临床研究  

Efficacy and safety of active transfer of plaque versus provisional stenting with drug-eluting stents for the treatment of coronary bifurcation lesions

作　　者：申华[1] 杨丽霞[1] 王志坚[1] 纪征[2] 刘斌[3] 李学奇[4] 贾绍斌[5] 杨清 吕赛[1] 周玉杰[1] Shen Hua;Yang Lixia;Wang Zhijian;Ji Zheng;Liu Bin;Li Xueqi;Jia Shaobin;Yang Qing;Lyu Sai;Zhou Yujie(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Disease,Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease,Clinical Center For Coronary Heart Disease,Capital Medical University,Beijing 100029,China;Department of Cardiology,Tangshan Workers′ Hospital,Tangshan,Hebei 063000,China;Department of Cardiology,Second Hospital of Jilin University,Changchun 130041,China;Department of Cardiology,Fourth Hospital of Harbin Medical University,Harbin 150000,China;Department of Cardiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Cardiology,Tianjin Medical University General Hospital,Tianjin 300000,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京市心肺血管疾病研究所,冠心病精准治疗北京市重点实验室,首都医科大学冠心病临床诊疗与研究中心,100029 [2]唐山工人医院心血管内科,063000 [3]吉林大学第二附属医院心血管内科,长春130041 [4]哈尔滨医科大学附属第四医院心血管内科,150000 [5]宁夏医科大学总医院心血管内科,银川750004 [6]天津医科大学总医院心血管内科,300000

出　　处：《中华心血管病杂志》2019年第7期549-553,共5页Chinese Journal of Cardiology

基　　金：国家重点研发计划"精准医学研究"重点专项(2017YFC0908800);北京市医院管理局"登峰"计划专项经费(DFL20150601);北京市医院管理局"使命"计划专项经费(SML20180601);北京市卫生健康委员会科技创新中心建设项目(PXM2019_026272_000006;PXM2019_026272_000005).

摘　　要：目的比较边支斑块主动转移(ATP)技术与即兴支架术治疗冠状动脉分叉病变患者的有效性和安全性.方法本研究是一项多中心前瞻性观察性研究,共入选了2010年1月至2014年1月于北京安贞医院等6家医院行经皮冠状动脉介入治疗(PCI)的1136例分叉病变患者,PCI术后根据术式分为ATP组(560例)和即兴支架术组(576例).主要研究终点为1年内靶病变血运重建,次级终点为1年内全因死亡、心原性死亡、心肌梗死、支架内血栓、卒中和再发心绞痛.结果两组患者基线资料包括年龄、性别、高血压、糖尿病、高脂血症、吸烟史等差异均无统计学意义(P均>0.05).ATP组边支心肌梗死溶栓试验(TIMI)血流<3级[1.6%(9/560)比7.5%(43/576),P<0.01]、边支急性闭塞[1.3%(7/560)比7.1%(41/576),P<0.01]和边支置入支架的发生率[1.8%(10/560)比7.8%(45/576),P<0.01]明显低于即兴支架术组.术后12个月时,ATP组与即兴支架术组靶病变血运重建发生率差异无统计学意义[4.6%(26/560)比4.0%(23/576),P=0.66].结论ATP与即兴支架术治疗分叉病变均有较高的有效性和安全性.由于ATP可以有效降低靶分支血管置入支架的发生率,故其在治疗分叉病变方面具有潜在优势.Objective To compare the efficacy and safety of active transfer of plaque(ATP)versus provisional stenting(PS)with drug-eluting stents(DES)for the treatment of coronary bifurcation lesions.Methods A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial,patients were divided into either ATP(n=560)or PS group(n=576)accordingly.The primary endpoint was target lesion revascularization within 1 year,and the second endpoints were all-cause death,cardiogenic death,myocardial infarction,stent thrombosis,stroke,recurrent angina within 1 year.Results There were no significant differences in age,sex,hypertension,diabetes,hyperlipidemia and smoking history between the two groups(P>0.05).The incidence of TIMI blood flow<3 grade in the side branch(1.6%(9/560)vs.7.5%(43/576),P<0.01),acute occlusion of the side branch(1.3%(7/560)vs.7.1%(41/576),P<0.01)and implanted stents of side branch(1.8%(10/560)vs.7.8%(45/576),P<0.01)were significantly lower in the ATP group than those in the PS group.During the one year follow up,the rate of target lesion revascularization was similar between ATP group and PS group(4.6%(26/560)vs.4.0%(23/576),P=0.66).Conclusions The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique.However,ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.

关 键 词：冠状动脉疾病 经皮冠状动脉介入治疗 分叉病变 边支斑块主动转移技术 

分 类 号：R541.4[医药卫生—心血管疾病]