Effect Of Double Stent Technology On TIMI Flow In Left Main Bifurcation Disease

Research BACKGROUDAcute coronary syndrome(ACS)is a group of clinical syndromes of coronary artery atherosclerotic plaque rupture or invasion,secondary complete or incomplete occlusive thrombosis,while Percutaneous coronary intervention(PCI)is one of the most important treatment methods for ACS.Left main bifurcation disease(LMBD)accumulate left main trunk,left anterior descending(LAD)and left circumflex artery(LCX),with severe stenosis,Which often formed inverted Y-shaped,in addition the degree of stenosis>50%.LMBD accounts for a significant proportion of patients with ACS but previous studies of LMBD therapy focused on the choice of coronary artery bypass graft(CABG)or PCI.Interventional treatment is mainly how to choose a simple single bracket or complex double stents.Nevertheless,there are very limited studies on the immediate efficacy of different double stents approaches for the treatment of left main bifurcation of patients with ACS.This study focuse on the analysis of four different double stents approaches of LMBD efficacy,furthermore through the ACS patients with LMBD stent implantation after the immediate treatment outcome and the recent follow-up results to study in order to find out the differences between various approaches then screen out one or more of the better results applied to clinical work.Research objects and methods1.Study ObjectThis study consecutively included the patients who were diagnosed as Left Main bifurcation by coronary angiography and treat with double stents approaches in Guangdong Cardiovascular Institute from January 2010 to December 2014.157 cases were collected for baseline data such as age,sex,underlying disease,and left ventricular ejection fraction.2.Inclusion and Exclusion criteriaInclusion criteria:In this study,ACS patients who underwent double-stenting with LM bifurcation in Guangdong Cardiovascular Institute from January 2010 to December 2014 were enrolled.Exclusion criteria:The patients were excluded with(1)Simple left main opening lesions,body lesions;(2)unable tolerate antiplatelet therapy;(3)emergency PCI;(4)catheter operation led to the left main trunk and the need for emergency implantation of the stent;(5)cardiogenic shock;Grouping:The patients were divided into 3 groups according to the double stents approaches,45 cases of Crush Group(29%),76 cases of Culotte Group(48%)and T Group in 36 cases(23%).3.Statistical analysisStatistical analysis using SPSS 13.0 statistical software for processing,the normal distribution of measurement data to X ± s said comparison between groups using analysis of variance or two independent samples t test;count data as a percentage(%)that the use of chi-square test to compare.Logistic regression was used to explore the effect of different double stent techniques on intraoperative complications.The dependent variable was the presence of intraoperative complications;the variables with single factor p value less than 0.1 were used as independent variables.The Wald test was used to analyze the influence of double stent technique on intraoperative complications.The odds ratio(OR)and 95%confidence intervals(CI)were used to analyze the difference.P<0.05 was considered statistically significant.RESULTS1.different double-stent technology for anterior descending artery(LAD)TIMI blood flow factorsBefore post-dilatation,TIMI flow in the anterior descending(LAD)was assessed.TIMI flow was less than grade 3 in 17(10.8%)patients and the incidence of TIMI increased gradually in both groups.Comparisons between the two groups showed that relative In the Crush technique,the rate of LAD TIMI blood flow was less than grade 3 after Culotte technique operation(2.2%vs 15.8%,p = 0.043).We also analyzed the proportion of successful kisses between the Crush and Culotte techniques in two groups,with no significant difference between the two groups(91.1%vs 85.5%,p = 0.368)2.different double stent technology on the impact of intraoperative complicationsA composite adverse event consisting of angina pectoris,acute heart failure,and coronary artery dissection was defined as an intraoperative complication rate of 38(24.2%).Culotte had higher intraoperative complications than Crush(11.1%vs 31.6%,p = 0.011).In order to analyze the influencing factors of intraoperative complications,the selected groups were divided into two groups according to the presence or absence of intraoperative complications.The results showed that the LVEF was lower in the complication group(54.0 ± 12.9 vs 59.6 ± 12.0,p = 0.030)and the total length of the left main stent was longer(49.3 ± 11.1 vs 44.2 ± 11.2,p =0.016,)Logistic regression was used to explore the effect of different double-stent techniques on intraoperative complications.There were intraoperative complications that occurred as dependent variables and univariate p-values of less than 0.1 as independent variables.Analysis revealed that Culotte was an independent risk factor for intraoperative complications relative to Crush with an OR of 3.398(95%CI:1.172,9.857,p = 0.024)(Table 3).In addition,the longer the left main stent was also a risk factor(OR = 1.042,95%CI:1.005,1.081,p=0.028).CONCLUSIONIn Crush,Culotte,T three double-stent technology;Crush technology relative to the other two groups of LAD TIMI blood flow less.Crush technology is less likely to have intraoperative complications,and Culotte is an independent risk factor for intraoperative complications.The total length of the left main stent is also a risk factor for intraoperative complications.