| [Background]With the studies of left main lesion increasing,the awareness of left main lesion was also constantly changing and mature.The finding of coronary angiography(CAG)and the application of intravascular ultrasound(IVUS)allowed us to identify the left main lesion and evaluate its anatomical features intuitively and accurately.Consequently studies about left main lesion was also emerging in endlessly.The coronary artery bypass surgery(CABG)has long been regarded as the standard for the treatment of the unprotected left main coronary artery(ULMCA)lesions which were the contraindication of percutaneous coronary intervention(PCI),but with the emergence of the drug-coated stents and many favorable results of randomized clinical trials,the deep-rooted concept has been gradually shaken,and the related guidelines were major updated subsequently,which modified and upgraded the interventional treatment of the unprotected left main disease from original contraindications to the indications as class IIa recommendation(Level of Evidence: B)(SYNTAX 32 minutes or less),even for the selected left main lesions as class I recommendation(Level of Evidence: B)(SYNTAX less than 22),which provided strong evidence for interventional doctor undoubtedly.With the development and progress of interventional devices and the maturity of interventional technology for left main disease and the advent of the new generation of stents,currently interventional therapy for ULMCA disease has become a way of revascularization that could be comparable to CABG.The most complex and changeable one of the left main lesions is the left main distal bifurcation lesions,of which the intervention strategy can be simply summed up as two ways: 1-stent technology and 2-stent technology.Both have their advantages and disadvantages.For example,1-stent technique is simple,catering to the "as simple as possible" interventional principle,which destroys less about the original vascular reconstruction and can be more acceptable to the patient and performer,but there are several disadvantages,such as the side impact due to the crossover technique.2-stent technique can achieve better immediate effect,but it is relatively complex,and changes the original vascular structures that may affect the long-term prognosis.Selection of interventional treatment strategies about such lesions remains controversial,and the results of relevant research are also different.The superiority of two treatment strategies for patients with unprotected left main bifurcation lesions remains inconclusive,and the available clinical data is relatively lack.[Objective]This article aims to explore the effects on the clinical results of different interventional strategies for unprotected left main bifurcation lesions and provide interventional doctors more reference and theoretical basis for treating left main lesion,by retrospectively analyzing the clinical basic data and intervention strategy information,[Methods]136 patients are selected from the Cardiovascular Internal Medicine of the First Affiliated Hospital of Zhengzhou University between January 2012 and January 2012,whose coronary angiography showed unprotected left main distal bifurcation lesions,and we collected their detailed clinical data,including clinical histories inspection results and related data of interventional operation,postoperative complications and major adverse cardiovascular events(MACE)during hospitalization and 1-year follow-up,and made retrospective statistical analysis.MACE consist of cardiac death,myocardial infarction(MI),target lesion revascularization(TLR).Inclusion criteria: 1.Coronary angiography shows the left main distal bifurcation lesion(luminal stenosis > 50%);2.The left main does not exist unblocked grafts or good collaterals;3.All patients use drug-eluting stents(DES).Exclusion criteria: 1.Acute or chronic occlusion of the left main;2.Left main lesion with heavy calcification needs rotational ablation;3.Left main bifurcation with in-stent restenosis;4.Left main lesion caused by interventional operation needs rescue coronary stent implant;5.Malignant disease with life expectancy less than 1 year;6.A history of CABG;7.Left main lesion with severe cardiopulmonary dysfunction;8.Left main lesion with severe liver and kidney dysfunction;9.Left main lesion merging other severe heart disease such as severe valvular disease,cardiomyopathy and malignant arrhythmias.According to the use of stents for treatment of the left main bifurcation lesion,we divide 136 patients into two groups: 1-stent group(n = 74)and 2-stent group(n = 62)and record all the clinical data,coronary angiography result and follow-up data.We use statistical software SPSS17.0 to make a statistical analysis for the relevant data of the two groups,considering p < 0.05 to be statistically significant.[Results](1)A total of 136 patients with left main bifurcation lesions were included,of which 74 patients were with single stent,and 62 patients with double stents,No severe perioperative complications(such as acute cerebral hemorrhage,acute gastrointestinal bleeding event,contrast-induced nephropathy and encephalopathy,acute stent thrombosis,acute cardiac tamponade,etc.)occurred;no MACE occurred between the two groups during hospitalization.(2)SYNTAX score in 1-stent group was higher than 2-stent group.In mild ones(namely SYNTAX ≤22)1-stent group had a relatively higher proportion than 2-stent group,and a lower proportion than 2-stent group in moderate and severe ones(SYNTAX ≥23),whose difference was statistically significant.The proportion of true bifurcation(Medina 1,1,1 and 1,0,1)in 1-stent group was relatively lower than 2-stent group,while the pseudo bifurcation(Medina 1,1,0)in 1-stent group was higher,whose difference was statistically significant.(3)During 1 year follow-up period,MACE rate was higher in 2-stent group than 1-stent group,and the difference between them was statistically significant(p < 0.05);TLR occurred at a higher rate in 2-stent group than in 1-stent group(p < 0.05),while the incidence of MI and cardiac death had no statistical difference between the two groups(p>0.05).Layered analysis results about SYNTAX score and Medina classification of two groups of patients showed: among patients with mild disease,the incidence of MACE in 1-stent group was significantly smaller than in 2-stent group(p < 0.05),which was mainly embodied in TLR(p < 0.05);Among patients with moderate and severe lesions,the incidence of MACE in two groups was no significant difference;Whether true bifurcation(Medina1,1,1 and 1,0,1),or pseudo bifurcation lesions(Medina1,1,0),the incidence of MACE and TLR was no significant difference.[Conclusion]1.The accurate evaluation of the property and anatomical features of left main lesion plays an important role in selecting the intervention strategies.2.With the lesion and anatomical characteristics of left main bifurcation lesions relatively simple,single stent strategy may be a more appropriate choice,while with the lesion and anatomical features of left main bifurcation lesions more complex,single stent strategy is not inferior to double stents strategy. |
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