Comparison Of Simple And Complex Stenting Techniques In The Treatment Of Coronary Bifurcation Lesions

Objective:The application of simple and complex stents techniques is observed and analyzed, and then the immediate effects and long effects is compared by the two techniques. The paper is mainly on choosing the optimal technique of bifurcation lesions.Methods:Clinical data of patients with bifurcation lesions treated by PCI of Cardiology of Shandong Provincial Hospital from January2009to April2012were collected and analyzed retrospectively. General state of health, related risk factors, biochemical indicators, ultrasound of cardiology are involved in the collected data. The patients are divided into two groups:simple stenting technique group and complex stenting technique group, according to the coronary angiographic features. Syntax score was calculated and was used to risk stratification:low-risk group with score≤22, median-risk group with score of23～32, high-risk group with score≥33. All the patients were followed up after the PCI, and major adverse cardiac events(MACEs, including death, myocardial infarction, and target vessel revascularization) in hospital and out of hospital were recorded. The difference of MACEs and clinical data between groups were analyzed. Chi-square test was carried out on the basis of a statistical software named SPSS17.0.Results:1.66patients with true bifurcation lesions were procured, with mean age of60.23, and50of them were male. The clinical diagnosis of them were respectively48pectoris anginas,8old myocardial infarctions, and17new myocardial infarctions. Meanwhile,38patients were suffered from hypertension,19were suffered from diabetic mellitus, and49patients were observed to be abnormal in lipid. And45patients were long-time smokers.2.The coronary angiography outcomes showed that there were21patients with bifurcation lesions from the distant end of Left Main Branch,40patients with Left Anterior Descending-Diagonal,3patients in Left Circumflex Branch-Obtuse marginal branch, and2patients with trigeminal lesions from Right Coronary Artery.35patients were treated with stenting in main branch and balloon dilating in side branch. Another31patients were performed with stenting in both main and side branch.98.5%of patients (65/66) were successfully treated, with one suffering from left main dissection. The patient was successfully cured after emergency balloon dilation.3.One in-hospital patient with subacute thrombus was cured with thrombus aspiration. No MACEs were observed from other patients. During the out-hospital follow up,7patients experienced target vessel revascularization, with5PCIs and2coronary artery bypass graftings.1person died. And myocardial infarction occurred in3patients.77.3%of the patients were asymptomatic.4.The basic clinical data were almost the same between the simple simple stenting technique group and complex stenting technique group. There was also no significant difference of MACE between them(11.4%vs.16.1%, p=0.72). However, the MACE was quite different among the Syntax groups(low-risk group0.0%vs. median-risk group15.0%vs. high-risk group40.0%, p<0.01).Conclusions:1.The complex stenting technique didn’t show advantage in the MACE. Meanwhile, due to the high expenditure and long time operative time of the complex stenting technique, the simple stenting technique is the optimal option for bifurcation lesions.2.Patients with higher Syntax score are more likely to suffer from MACE. So the Syntax score can be used to be the predictor of MACE.