双对吻挤压与经典挤压技术治疗冠状动脉分叉病变的前瞻性、随机、多中心研究

被引：5

作者：

CHEN Shao-liang

ZHANG Jun-jie

YE Fei

SHAN Shou-jie

ZHU Zhong-sheng

LIN Song

TIAN Nai-liang

LI Xiao-bo

LIU Zhi-zhong

YUAN Zheng-bai

QIAN Jun

SUN Xue-wen

YANG Song

CHEN Jin-guo

机构：

[1] 南京医科大学附属南京第一医院心内科

[2] 首都医科大学附属北京安贞医院

[3] 新加坡国立大学医院

[4] 印度Kraishina心脏中心

[5] 日本德州会医学中心

[6] 以色列Wolfson医学中心

[7] 中国香港皇家玛丽医院

[8] 上海交通大学附属第六人民医院

[9] 上海同济大学附属第十人民医院

[10] 上海交通大学附属仁济医院

[11] 日本大阪国立循环器中心

来源：

中华心血管病杂志 | 2008年 / 02期

关键词：

冠状动脉疾病; 支架; 冠状动脉分叉病变; DK;

D O I：

暂无

中图分类号：

R686 [筋腱、韧带、滑囊疾病及损伤];

学科分类号：

摘要：

目的比较双对吻挤压(DK crush)和经典挤压技术治疗冠状动脉分叉病变的临床效果.方法 311例真性分叉病变患者随机分入DK crush组(n=155)和经典挤压组(n=156),随访时间8个月.一级及二级终点分别为主要心脏不良事件(MACE,包括心肌梗死、心原性死亡和靶病变血运重建)和血管直径再狭窄及晚期丢失.结果 DK crush组糖尿病患者较多.经典挤压组及DKcrush组最终对吻扩张(FKBI)成功率分别为76%和100%(P<0.001).DK crush术式的不足包括造影剂用量大(P=0.04)、球囊数量多(P<0.01)、手术时间长(P<0.001),但是对吻扩张不满意率显著减少(27.6%比6.3%,P<0.01).临床随访率为100%,冠状动脉造影随访率为82%.经典挤压组累计再狭窄率为32.3%,而DK crush组为20.3%(P=0.01),经典挤压组分支血管再狭窄率高(24.4%比12.3%,P=0.01),而两组间主干血管再狭窄率差异无统计学意义.经典挤压组术后8个月时的累计MACE发生率为24.4%(FKBI失败组为35.9%,FKBI成功组为19.7%),显著高于DK crush组(11.4%,P=0.02).经典挤压组血栓栓塞率为3.2%(FKBI失败组为5.1%,FKBI成功组为1.7%),而DK crush组为1.3%(P>0.05).经典挤压组术后8个月时无靶病变血运重建生存率为75.4%(FKBI失败组为71.2%,FKBI成功组为77.6%),而DK crush组为89.5%(P=0.002).结论 DK crush可能是治疗冠状动脉分叉病变的较佳术式。

引用

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