单支架与双支架术式分支球囊保护策略对冠状动脉前降支分叉病变患者的疗效比较研究

背景冠状动脉前降支分叉病变发生率及术后不良心血管事件发生率高,而明确合适的球囊保护策略对改善患者预后具有重要意义。目的比较单支架与双支架术式的分支球囊保护策略对冠状动脉前降支分叉病变的疗效。方法选取2015年1月—2018年1月都江堰市医疗中心收治的冠状动脉前降支真性分叉病变患者260例,根据分支球囊保护策略分为观察组(n=108)和对照组(n=152)。在基础治疗上,对照组患者采用双支架术式分支球囊保护策略,观察组患者采用单支架术式分支球囊保护策略。记录两组患者手术时间,球囊使用数量,支架植入数量,导丝使用数量,对比剂用量,术中分支血管慢血流、血流限制性夹层/分支血管闭塞,术后心肌梗死、心肌酶谱增高、主支及分支血管TIMI血流3级发生率,观察随访期间两组患者不良心脑血管事件及靶血管再次血运重建方式。结果观察组患者手术时间短于对照组,球囊使用数量、支架植入数量、导丝使用数量、对比剂用量低于对照组(P<0.05)。两组患者术中分支血管慢血流、血流限制性夹层/分支血管闭塞发生率及术后心肌梗死,心肌酶谱增高,主支、分支血管TIMI血流3级,再发心绞痛,主分支血管再狭窄,非致死性心肌梗死发生率比较,差异均无统计学意义(P>0.05)。观察组患者再狭窄程度高于对照组(P<0.05)。两组患者再次行经皮冠状动脉介入治疗、冠状动脉旁路移植术率比较,差异无统计学意义(P>0.05)。结论单支架及双支架术式的分支球囊保护策略治疗冠状动脉前降支真性分叉病变患者效果较好,与双支架术式比较,单支架术式可缩短患者手术时间,减少球囊使用数量、支架植入数量、导丝使用数量及对比剂用量,但会增加患者再狭窄程度。

Comparative Study of Single-stent versus Double-stent Strategy in Patients of Bifurcation Lesions Involving the Anterior Descending Coronary Artery

Background Both anterior descending coronary bifurcation lesions and related postoperative adverse events have high incidence,so it is of great significance to identify an appropriate balloon dilatation strategy for improving the prognosis of these patients.Objective To compare the effect of single-stent and double-stent strategies on bifurcation lesions involving the anterior descending coronary artery.Methods 260 patients with true bifurcation lesions involving the anterior descending coronary artery from Dujiangyan Medical Center were selected from January 2015 to January 2018.Among them,108 received primary treatment plus single-stent technique,and other 152 received primary treatment plus double-stent technique were assigned to the observation group and control group,respectively.The operative time,number of balloons,guide wires,and amount of contrast agent used,and number of stents implanted,incidence of intraoperative slow flow within the side branch,dissection of the anterior descending artery with impaired blood flow/side branch occlusion,postoperative myocardial infarction,increased cardiac enzyme profile,and TIMI blood flow grade 3 of main and side branches,and the incidence of adverse cardio-cerebrovascular events as well as methods used for target vessel revascularization during the follow-up period in both groups were recorded.Results The observation group used shorter average operative time,and less average number of balloons,stents,guide wires and amount of contrast agent than the control group(P<0.05).There was no significant difference in the incidence of intraoperative slow flow within the side branch,dissection of the anterior descending artery with impaired blood flow/side branch occlusion,postoperative myocardial infarction,increased cardiac enzyme profile,TIMI blood flow grade 3 of main and side branches,recurrent angina,restenosis of main and side branches,or non-fatal myocardial infarction between the two groups(P>0.05).The overall restenosis degree in observation group was significantly higher than that in control group(P<0.05).The rates of receiving re-PCI treatment and coronary artery bypass grafting were similar in both groups(P>0.05).Conclusion Both strategies are effective in treating patients with true bifurcation lesions involving the anterior descending coronary artery.Single-stent technique requires shorter operative time,and uses less number of balloons,and stents implanted,guide wires and amount of contrast agent,but may yield increased risk of restenosis.