Randomized Comparisons Between Different Stenting Approaches for Bifurcation Coronary Lesions With or Without Side Branch Stenosis

被引：91

作者：

Kim, Young-Hak ^{[1
]}

Lee, Jae-Hwan ^{[2
]}

Roh, Jae-Hyung ^{[1
]}

Ahn, Jung-Min ^{[1
]}

Yoon, Sung-Han ^{[1
]}

Park, Duk-Woo ^{[1
]}

Lee, Jong-Young ^{[1
]}

Yun, Sung-Cheol ^{[3
]}

Kang, Soo-Jin ^{[1
]}

Lee, Seung-Whan ^{[1
]}

Lee, Cheol Whan ^{[1
]}

Seung, Ki Bae ^{[4
]}

Shin, Won-Yong ^{[5
]}

Lee, Nae-Hee ^{[6
]}

Lee, Bong-Ki ^{[7
]}

Lee, Sang-Gon ^{[8
]}

Nam, Chang-Wook ^{[9
]}

Yoon, Junghan ^{[10
]}

Yang, Joo-Young ^{[11
]}

Hyon, Min-Su ^{[12
]}

Lee, Keun ^{[13
]}

Jang, Jae-Sik ^{[14
]}

Kim, Hyun-Sook ^{[15
]}

Park, Seong-Wook ^{[1
]}

Park, Seung-Jung ^{[1
]}

机构：

[1] Asan Med Ctr, Div Cardiol, Seoul, South Korea

[2] Chungnam Natl Univ Hosp, Taejon, South Korea

[3] Asan Med Ctr, Div Biostat, Seoul, South Korea

[4] Catholic Univ Korea, St Marys Hosp, Seoul, South Korea

[5] Cheonan Hosp, Cheonan, South Korea

[6] Bucheon Hosp, Bucheon, South Korea

[7] Kangwon Natl Univ Hosp, Chunchon, South Korea

[8] Univ Ulsan, Coll Med, Ulsan Univ Hosp, Ulsan 680749, South Korea

[9] Keimyung Univ, Dongsan Med Ctr, Daegu, South Korea

[10] Yonsei Univ, Wonju Severance Christial Hosp, Wonju, South Korea

[11] Ilsan Hosp, Natl Hlth Insurance Corp, Ilsan, South Korea

[12] Soonchunhyang Univ Hosp, Seoul, South Korea

[13] Vet Hosp, Seoul, South Korea

[14] Busan Paik Hosp, Busan, South Korea

[15] Hallym Univ, Sacred Heart Hosp, Anyang, South Korea

来源：

JACC-Cardiovascular Interventions | 2015年 / 8卷 / 04期

关键词：

bifurcation; coronary artery disease; restenosis; stent; SIROLIMUS-ELUTING STENTS; FRACTIONAL FLOW RESERVE; LONG-TERM OUTCOMES; CRUSH TECHNIQUE; INSIGHTS; INTERVENTION; IMPLANTATION; PREDICTORS; DILATION;

D O I：

10.1016/j.jcin.2015.01.016

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

OBJECTIVES This study sought to evaluate the optimal percutaneous coronary intervention techniques using drug-eluting stents for bifurcation coronary lesions. BACKGROUND The optimal bifurcation stenting technique needs to be evaluated. METHODS The trial included 2 randomization studies separated by the presence of side branch (SB) stenosis for patients having non-left main bifurcation lesions. For 306 patients without SB stenosis, the routine final kissing balloon or leave-alone approaches were compared. Another randomization study compared the crush or single-stent approaches for 419 patients with SB stenosis. RESULTS Between the routine final kissing balloon and leave-alone groups for nondiseased SB lesions, angiographic restenosis occurred in 17.9% versus 9.3% (p = 0.064), comprising 15.1% versus 3.7% for the main branch (p = 0.004) and 2.8% versus 5.6% for the SB (p = 0.50) from 214 patients (69.9%) receiving 8-month angiographic follow-up. Incidence of major adverse cardiac events including death, myocardial infarction, or target vessel revascularization over 1 year was 14.0% versus 11.6% between the routine final kissing balloon and leave-alone groups (p = 0.57). In another randomization study for diseased SB lesions, 28.2% in the single-stent group received SB stents. From 300 patients (71.6%) receiving angiographic follow-up, between the crush and single-stent groups, angiographic restenosis rate was 8.4% versus 11.0% (p = 0.44), comprising 5.2% versus 4.8% for the main branch (p = 0.90) and 3.9% versus 8.3% for the SB (p = 0.12). One-year major adverse cardiac events rate between the crush and single-stent groups was 17.9% versus 18.5% (p = 0.84). CONCLUSIONS Angiographic and clinical outcomes were excellent after percutaneous coronary intervention using drug-eluting stents with any stent technique for non-left main bifurcation lesions once the procedure was performed successfully. (C) 2015 by the American College of Cardiology Foundation.

引用

页码：550 / 560

页数：11

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