刘志忠,单守杰,张俊杰,田乃亮,叶飞,林松,陈绍良

• 1:南京医科大学附属南京医院(南京市第一医院)心血管内科
• 2:南京市心血管病医院

摘要(Abstract)：

目的探讨糖尿病合并冠状动脉分叉病变人群采用单双支架策略的预后差异。方法回顾性研究了入选DK-CrushⅠ～Ⅳ系列试验的糖尿病合并冠状动脉真性分叉病变患者211例。其中,单支架策略组(PS组)119例,双支架策略组(DS组)92例,均使用了雷帕霉素洗脱支架。PS组于下述情况以"T"支架术式置入分支支架:(1)分支血管残余狭窄≥50%;(2)TIMI血流小于3级;(3)合并B型以上夹层。DS组采用DK-Crush技术56例(60.9%),"T"型支架置入技术26例(28.3%),Culotte技术置入10例(10.9%)。无论DS组抑或PS组在支架置入后均强调完成分支高压后扩张和主、分支最终球囊对吻(FKI)。主要研究终点为术后9个月内的主要不良心脏事件(MACE,包括心源性死亡、非致死性心肌梗死、再发心绞痛,再次靶血管重建),次要研究终点为9个月时血管造影主支和分支血管再狭窄。结果 9个月随访期内DS组与PS组的发生MACE分别为12例(13.0%)和14例(11.8%),两组间差异无统计学意义(χ2=0.079,P>0.05)。随访血管造影主支再狭窄DS组与PS组分别为10例(10.9%)和12例(10.1%),组间比较无差异统计学意义(χ2=0.034,P>0.05),但分支再狭窄DS组18例(19.6%)显著低于PS组46例(38.7%),χ2=8.948,P=0.003。结论在糖尿病合并冠状动脉分叉病变患者中,单支架策略与双支架策略的9个月随访期的主要不良心脏事件无差异,但双支架策略显著减少了分支再狭窄。

关键词(KeyWords)： 冠状动脉疾病;糖尿病;血管成形术,经腔,经皮冠状动脉;药物洗脱支架

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘志忠,单守杰,张俊杰,田乃亮,叶飞,林松,陈绍良

参考文献(References)：

• [1]Kapur A,Hall RJ,Malik IS,et al.Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients.1-year results of the CARDia(Coronary Artery Revascularization in Diabetes)trial.J Am Coll Cardiol,2010,55:432-440.
• [2]Colombo A,Moses JW,Morice MC,et al.Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions.Circulation,2004,109:1244-1249.
• [3]Steigen TK,Maeng M,Wiseth R,et al.Randomized study on simple versus complex stenting of coronary artery bifurcation lesions:the Nordic bifurcation study.Circulation,2006,114:1955-1961.
• [4]Colombo A,Bramucci E,Sacca S,et al.Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations:the CACTUS(Coronary Bifurcations:Application of the Crushing Technique Using Sirolimus-Eluting Stents)Study.Circulation,2009,119:71-78.
• [5]吴雪锋,钱菊英.冠状动脉分叉病变的药物支架治疗进展.中国介入心脏病学杂志,2010,18:225-227.
• [6]Hildick-Smith D,de Belder AJ,Cooter N,et al.Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions:the British Bifurcation Coronary Study:old,new,and evolving strategies.Circulation,2010,121:1235-1243.
• [7]Movahed MR.Major limitations of randomized clinical trialsinvolving coronary artery bifurcation interventions:time for redesigning clinical trials by involving only true bifurcation lesions and using appropriate bifurcation classification.J Interv Cardiol,2011,24:295-301.
• [8]Chen SL,Santoso T,Zhang JJ,et al.A Randomized Clinical Study Comparing Double Kissing Crush With Provisional Stenting for Treatment of Coronary Bifurcation Lesions Results From the DKCRUSH-II(Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions)Trial.J Am Coll Cardiol,2011,57:914-920.
• [9]American Diabetes Association.Screening for type2diabetes.Diabetes Care,2004,27Suppl1:S11-S14.
• [10]Ferenc M,Gick M,Kienzle RP,et al.Randomized trial on routine vs.provisional T-stenting in the treatment of de novo coronary bifurcationlesions.Eur Heart J,2008,29:2859-2867.
• [11]Ge L,Airoldi F,Iakovou I,et al.Clinicaland angiographic outcome after implantation of drug-eluting stents in bifurcation lesions with the crush stent technique:importance of final kissing balloon post-dilation.J Am Coll Cardiol,2005,46:613-620.
• [12]Foin N,Secco GG,Ghilencea L,et al.Final proximal post-dilatation is necessary after kissing balloon in bifurcation stenting.EuroIntervention,2011,7:597-604.
• [13]Capodanno D,Tamburino C,Sangiorgi GM,et,al.Impact of drug-eluting stents and diabetes mellitus in patients with coronary bifurcation lesions:a survey from the Italian Society of Invasive Cardiology.Circ Cardiovasc Interv,2011,4:72-79.
• [14]Gwon HC,Choi SH,Song YB,et al.Long-term clinical results and predictors of adverse outcomes after drug-eluting stent implantation for bifurcation lesions in a real-world practice:the COBIS(Coronary Bifurcation Stenting)registry.Circ J,2010,74:2322-2328.