The feasibility of double stent strategy in left main true bifurcation with small and large angle change between diastole and systole: The Milan and New-Tokyo (MITO) registry.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Yusuke Watanabe, Toru Naganuma, Alaide Chieffo, Matteo Montorfano, Masaaki Okutsu, Satoko Tahara, Koji Hozawa, Sunao Nakamura, Antonio Colombo
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引用次数: 0

Abstract

Background: Provisional single stenting strategy (PSS) is a default strategy for percutaneous coronary intervention (PCI) of unprotected left main distal bifurcation lesions (ULMD). Previous study reported that a bifurcation angle change (BAC) between end diastole and systole was associated with outcomes after PCI with double stent strategy (DSS) for ULMD. However, there are no data comparing outcomes after PCI with PSS versus DSS according the degree of BAC.

Objectives: We evaluated outcomes after PCI with PSS versus DSS for true ULMD with small and large BAC.

Methods: We identified 566 patients with true ULMD underwent PCI in three high-volume centers. We calculated the BAC in ULMD between end-diastole and systole before stenting with 2-dimensional quantitative coronary angiographic assessment. We defined small (BAC < 7.0°) and large BAC (≥7.0°) group. We compared clinical outcomes after PCI with PSS versus DSS in each cohort after propensity score adjustment. The primary endpoint was target-lesion failure (TLF), which was defined as a composite of cardiac death, target lesion revascularization, and myocardial infarction.

Results: In small BAC cohort, TLF rate was significantly lower in DSS group than in PSS group (12.5% vs. 20.1%, adjusted HR 0.45; 95% CI, 0.26-0.79; p = 0.006). In contrast, in large BAC cohort, TLF rate was significantly higher in DSS group than in PSS group (54.9% vs. 29.0%, adjusted HR 2.25; 95% CI, 1.50-3.38; p < 0.001).

Conclusions: The TLF rate after PCI with DSS was significantly lower in true ULMD with small BAC compared to PSS even after propensity score adjustment. In contrast, it was significantly higher in those with large BAC.

舒张期和收缩期角度变化小和大的左主干真分叉双支架策略的可行性:米兰和新东京(MITO)登记。
背景:临时单支架策略(PSS)是对无保护左主干远端分叉病变(ULMD)进行经皮冠状动脉介入治疗(PCI)的默认策略。之前的研究报告显示,舒张末期和收缩末期之间的分叉角变化(BAC)与采用双支架策略(DSS)PCI 治疗 ULMD 后的预后有关。然而,目前还没有根据 BAC 的程度比较 PSS 与 DSS PCI 后疗效的数据:我们评估了对具有小和大 BAC 的真性 ULMD 患者采用 PSS 与 DSS 进行 PCI 治疗后的疗效:方法:我们在三家高流量中心确定了 566 名接受 PCI 治疗的真正 ULMD 患者。我们通过二维定量冠状动脉造影评估,计算了支架置入前 ULMD 在舒张末期和收缩期之间的 BAC。我们定义了小BAC结果:在小型 BAC 队列中,DSS 组的 TLF 率明显低于 PSS 组(12.5% vs. 20.1%,调整 HR 0.45;95% CI,0.26-0.79;P = 0.006)。相比之下,在大型 BAC 队列中,DSS 组的 TLF 率明显高于 PSS 组(54.9% vs. 29.0%,调整 HR 2.25;95% CI,1.50-3.38;p 结论:DSS 组的 TLF 率明显高于 PSS 组(54.9% vs. 29.0%,调整 HR 2.25;95% CI,1.50-3.38;p = 0.006):使用 DSS 进行 PCI 后的 TLF 率在 BAC 较小的真正 ULMD 中明显低于 PSS,即使经过倾向评分调整也是如此。相比之下,BAC 大的患者的 TLF 率明显更高。
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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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