SCI 발표논문

SCI 발표논문

← SCI 발표논문 목록

J Interv Cardiol. 2020;2020:2475930.

Clinical Implications of Bifurcation Angles in Left Main Bifurcation Intervention Using a Two-Stent Technique.

, , , , , , , , , , , , , ,

제1저자 기유정, 정지현 · 교신저자 한정규

PMID 32733170 PMC7374237 DOI 10.1155/2020/2475930 IF 1.4 순환기내과
소속 (8)
  1. Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of Korea.
  2. Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon 14754, Republic of Korea.
  3. Department of Internal Medicine, St. Carollo Hospital, Sunchon 57931, Republic of Korea.
  4. Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
  5. Inje University Ilsan Paik Hospital, Goyang 10380, Republic of Korea.
  6. Division of Cardiology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju 54987, Republic of Korea.
  7. Chonbuk National University Hospital, Jeonju 54907, Republic of Korea.
  8. Seoul National University Bundang Hospital, Sungnam 13620, Republic of Korea.

Abstract

OBJECTIVES The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique.

BACKGROUND Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI).

METHODS Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1st generation drug-eluting stent (DES), 37% 2nd generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR).

RESULTS In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the <152° group (35.7% vs. 14.6%; adjusted hazard ratio 3.476; 95% confidence interval 1.612-7.492). An LM-LAD angle ≥152° was an independent predictor of TLF. In the T-stenting, no bifurcation angle affected the clinical outcomes.

CONCLUSIONS In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.

Copyright © 2020 You-Jeong Ki et al.

Figures

Figure 1
Figure 1 Study population from 4 multicenter registries. EES, everolimus-eluting stent(s); LM, left main; PCI, percutaneous coronary intervention; TAP, T and protrusion; ZES-R, zotarolimus-eluting resolute stent.
Figure 2
Figure 2 Measurement of left main bifurcation angles. Virtual lines were drawn from the branch origin under the LAO caudal view, and the 3 bifurcation angles were measured. LAD, left anterior descending artery; LAO, left anterior oblique; LCX, left circumflex artery; and LM, left main.
Figure 3
Figure 3 Receiver operating characteristic curves showing sensitivity of each angle for predicting TLF risk in patients treated with (a) crush and (b) T-stenting technique. An LM-LAD angle of 152° was the best cutoff value for predicting TLF in the crush group. None of the bifurcation angles had a significant cutoff value in the T-stenting group. AUC, area under the curve; BCV, best cutoff value; CI, confidence interval; LAD, left anterior descending artery; LCX, left circumflex artery; LM, left main; TLF, target lesion failure.
Figure 4
Figure 4 Clinical impact of bifurcation angle after LM PCI using the crush technique versus T-stenting. (a) The clinical impact of LM-LAD angle after left main percutaneous coronary intervention using the crush technique versus T-stenting. (b) The clinical impact of the LAD-LCX angle after left main percutaneous coronary intervention using the crush technique versus T-stenting. HR, hazard ratio; LAD, left anterior descending artery; LCX, left circumflex artery; LM, left main; and PCI, percutaneous coronary intervention. The left column represents the crush strategy, and the right column represents the T-stenting strategy.
Figure 5
Figure 5 Schematic diagrams of LM bifurcation according to different LM-LAD angles. Blue ovals mean the balloon catheter, gray rectangles mean the stent, and arrows indicate wall shear stress. (a) Wide LM-LAD angle. (b) Narrow LM-LAD angle. LAD, left anterior descending artery; LCX, left circumflex artery; and LM, left main.

그림 출처: PubMed Central 공개 논문 (PMC7374237)

Conflict of interest statement

There are no relevant conflicts of interest.

그 밖의 정보
출판 형태
Journal Article
저널
Journal of interventional cardiology · eISSN 1540-8183
전자 출판
2020-07-11
MeSH
Coronary Angiography / methods · Coronary Artery Disease* / diagnosis / surgery · Coronary Restenosis* / diagnosis / etiology · Coronary Vessels* / diagnostic imaging / pathology · Drug-Eluting Stents / adverse effects · Female · Humans · Male · Middle Aged · Myocardial Infarction* / etiology / mortality · Outcome and Process Assessment, Health Care · Percutaneous Coronary Intervention* / adverse effects / instrumentation / methods
참고문헌
25편