Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions
Validation of bifurcation DEFINITION criteria and comparison of stenting strategies in true left main bifurcation lesions
复制标题
真性左主分叉病变分叉定义标准的验证和支架置入策略的比较
作者：
Juan Wang;C. Guan;Jue Chen;K. Dou;Yida Tang;Weixian Yang;Yanpu Shi;F. Hu;L. Song;Jiansong Yuan;J. Cui;Min Zhang;Shuang Hou;Yongjian Wu;Yue;S. Qiao;Bo Xu
对于真左主干（LM）分叉病变的最佳支架置入策略存在争议。本研究比较了根据定义标准区分的真正LM分叉病变患者的1次和2次支架置入策略。连续纳入928例经DES治疗的真LM分叉病变（Medina 1,1,1或0,1,1）患者。根据定义标准，297例（32.0%）患者被确定为复杂LM分叉组，631例（68.0%）患者被确定为简单LM分叉组。在30天（7.8% vs. 4.0%, p = 0.01）、1年（10.3% vs. 6.4%, p = 0.04）和3年（14.2% vs. 10.1%, p = 0.07）时，复杂LM分叉组患者的主要心脏不良事件（MACE，包括心源性死亡、心肌梗死[MI]和缺血驱动的靶血管重建术）发生率均显著高于单纯LM分叉组（MACE，包括心源性死亡、心肌梗死[MI]和缺血驱动的靶血管重建术），主要是由心肌梗死增加所致。双支架策略组患者的心脏死亡发生率在复杂LM分叉组（2.0% vs. 5.9%, p = 0.08）和简单LM分叉组（1.9% vs. 4.5%, p = 0.07）均有较低的趋势。总之，DEFINITION研究中建立的复杂分叉病变标准能够对LM分叉患者进行风险分层。无论LM分叉复杂性如何，双支架技术在数值上降低了3年心脏死亡率。
There are controversies on optimal stenting strategy regarding true left main (LM) bifurcation lesions. The present study compared 1- and 2-stenting strategy for patients with true LM bifurcation lesions as differentiated by DEFINITION criteria. 928 patients with true LM bifurcation lesions (Medina 1,1,1 or 0,1,1) treated with DES were enrolled consecutively. 297 (32.0%) patients were identified as complex LM bifurcation, and 631 (68.0%) patients into simple LM bifurcation group according to DEFINTION criteria. Patients in complex vs. simple LM bifurcation group had significantly higher major adverse cardiac event (MACE, including cardiac death, myocardial infarction [MI] and ischemia-driven target vessel revascularization) rate at 30 days (7.8% vs. 4.0%, p = 0.01), 1 year (10.3% vs. 6.4%, p = 0.04), and numerically at 3 years (14.2% vs. 10.1%, p = 0.07), which was mainly driven by increased MI. Moreover, patients in the 2-stent strategy group had strong trend towards lower incidence of cardiac death in both complex LM bifurcation group (2.0% vs. 5.9%, p = 0.08) and simple LM bifurcation group (1.9% vs. 4.5%, p = 0.07). In conclusion, the complex bifurcation lesion criteria established in DEFINITION study was able to risk-stratify LM bifurcation patients. Two-stent technique yielded numerically lower 3-year cardiac mortality regardless of LM bifurcation complexity.