Intracoronary Electrocardiography-guided Strategy for the Treatment of Coronary Bifurcation Lesions

IF 0.9 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Dobrin Vassilev, Niya Mileva, Panayot Panayotov, Krasimir Kostov, Kenan Yumerov, Nikolay Petkov, Carlos Collet, Gianluca Rigatelli, Robert J. Gil, Thach Nguyen
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Abstract

Introduction: Revascularization of bifurcation lesions remains an interventional challenge. Intracoronary electrocardiograms can predict the functional significance of side branch stenosis after bifurcation stenting. Aim: This study was aimed at evaluating the effects of an intracoronary ECG electrocardiography (icECG)-guided revascularization strategy, compared with the currently accepted standard of care, on the clinical outcomes of patients after coronary bifurcation stenting. Methods: Patients with coronary bifurcation lesions who underwent percutaneous revascularization were enrolled in a prospective all-comers’ registry. Clinical outcomes were compared between patients who underwent icECG-guided revascularization versus the current standard of care (SOC), provisional stenting. Results: A total of 768 patients were included in the analysis: 349 were treated with an icECG-guided strategy, and 419 received SOC. The overall all-cause death rate was 23.2%, and the cardiovascular death rate was 15.9%. Patients with icECG guidance had significantly lower all-cause mortality (20.3% vs. 25.5% for icECG vs. SOC, log-rank P = 0.006) and cardiovascular mortality (12.6% vs. 18.6% for icECG vs. SOC, log-rank P = 0.004). The decrease in mortality was most pronounced in patients with no increase or a moderate increase in troponin post-PCI, or with higher-than-normal baseline troponin concentrations. Conclusion: An icECG-guided strategy for coronary bifurcation PCI led to lower patient mortality than the provisional stenting strategy.
冠状动脉内心电图引导下治疗冠状动脉分叉病变的策略
分支病变的血运重建仍然是一个介入治疗的挑战。冠状动脉内心电图可预测分支支架置入术后侧支狭窄的功能意义。目的:本研究旨在评估冠脉内心电图的影响心电描记法(icECG)引导血管再生策略,与目前接受标准治疗相比,在冠状动脉分叉支架植入后病人的临床结果。方法:接受经皮血管重建术的冠状动脉分叉病变患者纳入前瞻性所有患者登记。临床结果比较了接受icecg引导下的血运重建术与目前的标准护理(SOC)临时支架植入术的患者。结果:共有768例患者纳入分析:349例采用icecg指导策略,419例接受SOC治疗。全因死亡率为23.2%,心血管死亡率为15.9%。在icECG指导下,患者的全因死亡率(icECG vs SOC为20.3%,log-rank P = 0.006)和心血管死亡率(icECG vs SOC为12.6%,log-rank P = 0.004)显著降低。在pci术后肌钙蛋白无升高或中度升高,或肌钙蛋白基线浓度高于正常水平的患者中,死亡率的降低最为明显。结论:icecg引导下冠状动脉分叉PCI的患者死亡率低于临时支架置入策略。
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来源期刊
Cardiovascular Innovations and Applications
Cardiovascular Innovations and Applications CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
0.80
自引率
20.00%
发文量
222
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