3-Dimensional Bifurcation Angle Analysis in Patients With Left Main Disease A Substudy of the SYNTAX Trial (SYNergy Between Percutaneous Coronary Intervention With TAXus and Cardiac Surgery)
3-Dimensional Bifurcation Angle Analysis in Patients With Left Main Disease A Substudy of the SYNTAX Trial (SYNergy Between Percutaneous Coronary Intervention With TAXus and Cardiac Surgery)
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DOI：
10.1016/j.jcin.2009.10.019
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发表时间：
2010-01-01
影响因子：
11.3
通讯作者：
Morice, Marie-Claude
中科院分区：
文献类型：
--
作者：
Girasis, Chrysafios;Serruys, Patrick W.;Morice, Marie-Claude
目的 我们探讨左冠状动脉主干 (LM) 的分叉角 (BA) 参数、经皮冠状动脉介入治疗 (PCI) 对此角度的影响，以及 BA 对临床结果的影响。 背景 BA 正在成为分叉病变 PCI 术后结果的预测因子。三维（3D）定量冠状动脉造影（QCA）克服了二维分析的缺点并提供可靠的数据。方法这是SYNTAX（经皮冠状动脉介入治疗与TAXus和心脏手术之间的协同作用）试验的子研究。使用 3D QCA 软件（CardiOp-B，Paieon Medical, Ltd.，Rosh Ha'ayin，以色列）对 354 名接受 LM 茎 PCI 的患者的电影血管造影进行了分析。在 PCI 之前和之后，在舒张末期和收缩末期计算近端 BA（LM 和左回旋支 [LCX] 之间）和远端 BA（左前降支和 LCX 之间）。随机化后整个 12 个月期间的累积主要不良心脏和心血管事件 (MACCE) 率根据 PCI 前远端 BA 值进行分层并进行相应比较。结果 完整分析在 266 名 (75.1%) 患者中是可行的。近端和远端 BA 的平均 PCI 前舒张末期值分别为 105.9 +/- 21.7 度和 95.6 +/- 23.6 度，并且呈负相关（r = -0.75，p < 0.001）。在心脏收缩运动期间，近端角增大，远端角减小（ABA 分别为 -8.2 度和 8.5 度，两者的 p < 0.001）。 PCI 导致远端 BA 平均下降（Delta BA 4.5 度，p < 0.001）。 MACCE 率在远端 BA 值之间没有差异； 12 个月时，舒张压值（第一到第三个三分位数）的 MACCE 自由度分别为 82.8%、85.4% 和 81.1% (p = 0.74)。 结论 使用 3D QCA 进行左主 BA 分析是可行的。近端角和远端角均受心脏运动的影响； PCI 改变远端角度。 PCI 前远端 BA 值的事件发生率没有明显差异。 （J Am Coll Cardiol Intv 2010；3:41-8）(C) 2010 年，美国心脏病学会基金会
Objectives We explore the bifurcation angle (BA) parameters of the left main coronary artery (LM), the effect of percutaneous coronary intervention (PCI) on this angulation, and the impact of BA on clinical outcome.Background The BA is emerging as a predictor of outcome after PCI of bifurcation lesions. Three-dimensional (3D) quantitative coronary angiography (QCA) overcomes the shortcomings of 2-dimensional analysis and provides reliable data.Methods This is a substudy of the SYNTAX (SYNergy Between Percutaneous Coronary Intervention With TAXus and Cardiac Surgery) trial. The cineangiograms of the 354 patients who underwent PCI of their LM stem were analyzed with 3D QCA software (CardiOp-B, Paieon Medical, Ltd., Rosh Ha'ayin, Israel). The proximal BA (between LM and left circumflex [LCX]) and the distal BA (between left anterior descending and LCX) were computed in end-diastole and end-systole, both before and after PCI. The cumulative major adverse cardiac and cardiovascular event (MACCE) rates throughout the 12-month period after randomization were stratified across pre-PCI distal BA values and compared accordingly.Results Complete analysis was feasible in 266 (75.1%) patients. Proximal and distal BA had mean pre-PCI end-diastolic values of 105.9 +/- 21.7 degrees and 95.6 +/- 23.6 degrees, respectively, and were inversely correlated (r = -0.75, p < 0.001). During systolic motion of the heart there was an enlargement of the proximal angle and a reduction of the distal angle (ABA -8.2 degrees and 8.5 degrees, respectively, p < 0.001 for both). The PCI resulted in a mean decrease in the distal BA (Delta BA 4.5 degrees, p < 0.001). The MACCE rates did not differ across distal BA values; freedom from MACCE at 12 months was 82.8%, 85.4%, and 81.1% (p = 0.74) for diastolic values (first through third tertile).Conclusions Left main BA analysis with 3D QCA is feasible. Both proximal and distal angles are affected by cardiac motion; PCI modifies the distal angle. There is no clear difference in event rates across pre-PCI distal BA values. (J Am Coll Cardiol Intv 2010;3:41-8) (C) 2010 by the American College of Cardiology Foundation