冠状动脉造影三维重建评估分叉角度对冠状动脉分叉病变介入治疗中分支血管闭塞的影响

目的:利用三维冠状动脉造影定量分析(3D-QCA)探讨分叉角度对冠状动脉分叉病变介入治疗中分支血管闭塞的影响。方法:收集从2012年1月至2012年3月间在阜外医院接受经皮冠状动脉介入治疗(PCI)的冠状动脉分叉病变患者176例,利用3D-QCA对分叉角度等分叉病变的相关参数进行分析。以所得血管分叉角度的中位数(49°)作为分界点,将所有患者分为两组:低角度组(≤49°,n=93)和高角度组(>49°,n=83)。分析两组患者分支血管的闭塞率,并通过多因素Logistic回归分析评价血管分叉角度对冠状动脉分叉病变介入治疗中分支血管闭塞的影响。结果:在176例分叉病变的介入治疗中,有8例(4.5%)出现分支血管闭塞。分支血管闭塞的发生率在高角度组明显大于低角度组(8.4%vs 1.1%,P=0.019)。随着血管分叉角度逐渐增大,分支血管闭塞发生率逐渐增高,第1四分位内为0%,第2四分位内为2.5%,第3四分位内为7.0%,第4四分位内为8.7%(P=0.027)。多因素Logistic回归分析显示,3D-QCA计算所得血管分叉角度大是分支血管闭塞的独立危险因素(OR=1.13,95%CI:1.005~1.271,P=0.041)。结论:3D-QCA证实,高血管分叉角度是主支血管支架置入后分支血管闭塞的独立预测因素。

Impact of Bifurcation Angle on Side Branch Occlusion During Coronary Bifurcation Intervention: Value of Three-dimensional Quantitative Coronary Angiography Analysis

Objectives:We aimed to investigate the impact of bifurcation angle(BA)on side branch(SB)occlusion during percutaneous coronary intervention in real world by three-dimensional quantitative coronary angiography(3D-QCA)method.Methods:A total of 176 consecutive patients with bifurcation lesions who received one stent technique were included.BA was calculated by 3D-QCA.The patients were divided into low angle(n=93)and high angle(n=83)groups according the median BA of our study(49°).Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion.Results:SB occlusion occurred in 8(4.5%)out of 176 bifurcation lesions.The rate of SB occlusion was significantly higher in the high angle group than in the low angle group(8.4%vs 1.1%,P=0.019).Multivariable analysis showed that high angle was an independent predictor of SB occlusion(OR:1.13,95%CI:1.005-1.271,P<0.041).Conclusions:Our results evaluated by the 3D-QCA method show that high BA is an independent predictor of SB occlusion the main vessel stent implantation.