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crush stenting in treating coronary bifurcate lesions： paclitaxel eluting stents versus sirolimus eluting stents

Chinese Medical Journal 2008年第6期121卷 528-533页

作者： CHEN Shao-liang ZHANG Jun-jie YE Fei CHEN Yun-dai ZHU Zhong-sheng LIN Song TIAN Nai-liang LIU Zhi-zhong FANG Wei-yi SUN Xue-wen HU Da-yi Tak W. Kwan Department of Cardiology Nanjing First Hospital NanjingMedical University Nanjing Jiangsu 210006 China Department of Cardiology Beijing Anzhen Hospital CapitalMedical University Beijing 100047 China Department of Cardiology Shanghai Chest Hospital Shanghai210005 China Department of Cardiology Peking University People's HospitalBeijing 100026 China Department of Cardiology Beth Israel Medical Centre New YorkUSA

Background Because no data regarding the comparison of crush stenting with paclitaxel （PES） or sirolimus eluting stents （SES） for coronary bifurcate lesions have been reported, we compared the clinical outcomes of these two types of stents. Methods Two hundred and thirty patients with 242 bifurcate lesions were enrolled in a prospective, nonrandomized trial Primary endpoints included myocardial infarction, cardiac death and target vessel revascularization at 8 months. Results All patients were followed up clinically and 82% angiographically at 8 months. Final kissing balloon inflation was performed in 72% in the PES and 75% in the SES groups （P〉0.05）. Compared to the SES group, PES group had a higher late loss and incidence of restenosis （P=0.04） in the prebifurcation vessel segment. The postbifurcation vessel segment in the PES group had a greater late loss （（0.7±0.6） mm vs （0.3±0.4） mm, P〈0.001） and higher restenosis in the side branch （25.5% vs 15.6%, P=0.04） when compared to the SES group. There was significant difference of insegment restenosis in the entire main vessel between PES and SES groups （P=0.004）. Target lesion revascularization was more frequently seen in the PES group as compared to the SES group （P=0.01）. There was significant difference in the accumulative MACE between these two groups （P=-0.01）. The survival rate free from target lesion revascularization was significantly higher in the SES group when compared to the PES group （P〈0.001）. Conclusion SES is superior to PES in reducing restenosis and target lesion revascularization by 8-month follow-up after crush stenting for bifurcate lesions.

关键词： drug eluting stent crush stenting bifurcate lesions

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Effect of coronary bifurcation angle on clinical outcomes in Chinese patients treated with crush stenting： a subgroup analysis from DKcrush-1 bifurcation study

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Chinese Medical Journal 2009年第4期122卷 396-402页

作者： CHEN Shao-liang ZHANG Jun-jie YE Fei CHEN Yun-dai FANG Wei-yi WEI Meng HE Ben SUN Xue-wen YANG Song CHEN Jin-guo SHAN Shou-jie TIAN Nai-liang LI Xiao-bo LIU Zhi-zhong KAN Jing Lee Michael Kwan Tak W Nanjing First Hospital Nanjing Medical University NanjingJiangsu 210006 China Department of Cardiology Beijing Anzhen Hospital CapitalMedical University Beijing 100029 China Department of Cardiology Shanghai Chest Hospital Shanghai 200030 China Department of Cardiology Shanghai Sixth Hospital Shanghai JiaoTong University School of Medicine Shanghai 200233 China Department of Cardiology Shanghai Renji Hospital Shanghai JiaoTong University School of Medicine Shanghai 200001 China Queen Mary Hospital Hongkong China Beth Israel Medical Center New York USA

Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classical or double kissing （DK） crush stenting for bifurcation lesions from the DKcrush-1 data base. Methods There were 212 patients with 220 lesions, some with low-angle （n=138） and some with high-angle （n=74）. Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events （MACEs）, defined as cardiac death, myocardial infarction and target lesion revascularization （TLR）. Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation （FKBI）. Results At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group （91.43%） and the low-angle group （82.39%）. In the high angle group, there was a significant difference in contrast volume used （P=0.005） but no significant difference in acute gain, minimum lumen diameter （MLD）, late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with- （n=-133） and without-FKBI （n=42）, significant side-branch late loss was seen in the group without-FKBI （（0.65±0.49） mm vs （0.47±0.62） mm, P=0.02）, with a resultant greater restenosis rate （37.68% vs 18.32%, P=0.001）. No difference was detected in the MACE free survival rate between the high and low angle groups （82.39% vs 82.36%, P=0.84）. The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference （P=0.38）. The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group （P=0.001）. Cox regression analysis showed that the independent predictors for target vessel revascularization were the

关键词： coronary bifurcation angle double kissing crush stenting

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