Randomized Comparison of Conservative Versus Aggressive Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions Results From the SMART-STRATEGY (SMart Angioplasty Research Team-Optimal STRATEGY for Side Branch Intervention in Coronary Bifurcation Lesions) Randomized Trial
Randomized Comparison of Conservative Versus Aggressive Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions Results From the SMART-STRATEGY (SMart Angioplasty Research Team-Optimal STRATEGY for Side Branch Intervention in Coronary Bifurcation Lesions) Randomized Trial
复制标题
DOI：
10.1016/j.jcin.2012.07.010
复制
发表时间：
2012-11-01
影响因子：
11.3
通讯作者：
Gwon, Hyeon-Cheol
中科院分区：
文献类型：
--
作者：
Song, Young Bin;Hahn, Joo-Yong;Gwon, Hyeon-Cheol
目的：作者试图比较在冠状动脉分叉病变的临时侧支（SB）介入治疗中保守和积极的策略。背景冠状动脉分叉病变的最佳临时入路尚未确定。方法在这项前瞻性随机试验中，258例接受药物洗脱支架治疗的冠状动脉分叉病变患者被随机分为保守（128例）和积极（130例）SB干预策略。主血管支架置入术后SB干预标准保守组与侵袭组存在差异；心肌梗死溶栓：非左主干分叉血流分级75%，径狭窄>75%，径狭窄>50%。主要终点是12个月时靶血管衰竭（心源性死亡、心肌梗死或靶血管重建术）。结果左主干分叉病变114例（44%），真主干分叉病变171例（66%）。保守组主血管支架术后SB球囊术和SB球囊术后SB支架术的发生率均低于侵袭组（分别为25.8%比68.5%,p < 0.001； 7.0%比30.0%,p < 0.001）。与积极策略相比，保守策略与手术相关心肌坏死的发生率较低（5.5% vs. 17.7%, p = 0.002）。12个月时，两组靶血管衰竭发生率相似（保守组为9.4%，侵袭组为9.2%,p = 0.97）。结论：与积极策略相比，临时SB干预的保守策略具有相似的长期临床结果和较低的手术相关心肌坏死发生率。冠状动脉分叉病变侧支支架置入术的优化策略[J]； journal of clinical nursing; 2012;5:1133-40) (C) 2012
Objectives The authors sought to compare conservative and aggressive strategies for provisional side branch (SB) intervention in coronary bifurcation lesions.Background The optimal provisional approach for coronary bifurcation lesions has not been established.Methods In this prospective randomized trial, 258 patients with a coronary bifurcation lesion treated with drug-eluting stents were randomized to a conservative (n = 128) or aggressive (n = 130) SB intervention strategy. The criteria for SB intervention after main vessel stenting differed between the conservative and aggressive groups; Thrombolysis In Myocardial Infarction flow grade 75% for non-left main bifurcations and diameter stenosis >75% versus diameter stenosis >50% for left main bifurcations. The primary endpoint was target vessel failure (cardiac death, myocardial infarction, or target vessel revascularization) at 12 months.Results Left main bifurcation lesions were noted in 114 patients (44%) and true bifurcation lesions in 171 patients (66%). SB ballooning after main vessel stenting and SB stenting after SB ballooning were performed less frequently in the conservative group than in the aggressive group (25.8% vs. 68.5%, p < 0.001; and 7.0% vs. 30.0%, p < 0.001, respectively). The conservative strategy was associated with a lower incidence of procedure-related myocardial necrosis compared with the aggressive strategy (5.5% vs. 17.7%, p = 0.002). At 12 months, the incidence of target vessel failure was similar in both groups (9.4% in the conservative group vs. 9.2% in the aggressive group, p = 0.97).Conclusions Compared with the aggressive strategy, the conservative strategy for provisional SB intervention was associated with similar long-term clinical outcomes and a lower incidence of procedure-related myocardial necrosis. (Optimal Strategy for Side Branch Stenting in Coronary Bifurcation Lesions [SMART-STRATEGY]; NCT00794014) (J Am Coll Cardiol Intv 2012;5:1133-40) (C) 2012 by the American College of Cardiology Foundation