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目的:观察并分析冠状动脉(冠脉)真性分叉病变边支血流储备分数处于临界值时不同治疗策略对患者的影响。方法:64例冠脉左前降支和对角支真性分叉病变并且边支血流储备分数处于临界值(0.75~0.80)的冠心病患者被分为两组,分别接受分叉病变双支架PCI治疗(双支架组,32例)和主支支架crossover PCI治疗(crossover组,32例),观察并分析两组患者术后1 2个月主要不良心血管事件(MACE)发生情况。结果:两组支架平均直径[(3.44±0.78)mm:(3.42±0.56)mm]、支架长度[(27.71±12.50)mm:(28.04±15.11)mm]差异无统计学意义(均P<0.05),但双支架组患者植入支架数显著增多[(2.13±0.98):(1.09±0.98),P<0.05),术中肝素用量显著增多[(7171.88±1734.89)u:(6 156.25±1 993.69)U,P=0.03],术中造影剂用量显著增多[(230.63±74.70)ml:(152.19±60.52)ml,P<0.05],手术时间(96.72±38.76)min:(77.34±1 7.51)min,P=0.012]及住院天数显著延长[(3.63+1.64)d:(2.05±1.07)d,P<0.05]。12个月随访,双支架组支架内再狭窄发生率略高于crossover组,MACE事件两组间差异无统计学意义(P=0.43)。结论:冠脉真性分叉病变且边支血流储备分数值处于临界值时给予主支支架crossover治疗安全有效。
OBJECTIVE: To observe and analyze the effect of different treatment strategies on patients with marginal branch flow reserve score of coronary artery (bifurcation) coronary lesions. METHODS: Sixty-four patients with coronary artery disease with left anterior descending coronary artery and diagonal branch bifurcation lesions and a borderline flow reserve score of between 0.60 and 0.80 were divided into two groups and received bifurcated dual stent PCI The patients in the double stent group (n = 32) and the crossover PCI group (n = 32) were enrolled in this study. The incidence of major adverse cardiovascular events (MACE) at 12 months after operation was observed and analyzed. Results: There was no significant difference between the two groups in average diameter [(3.44 ± 0.78) mm: (3.42 ± 0.56) mm] and stent length [(27.71 ± 12.50) mm: (28.04 ± 15.11) mm] ), But there was a significant increase in the number of stents implanted in the double stent group [(2.13 ± 0.98) :( 1.09 ± 0.98), P <0.05). The amount of heparin in the surgery group was significantly increased [(7171.88 ± 1734.89) u: (6 156.25 ± 1 992.69) U, P = 0.03]. There was a significant increase in the amount of contrast medium during the operation [(230.63 ± 74.70) ml: (152.19 ± 60.52) ml, P < ) min, P = 0.012] and length of hospital stay [(3.63 + 1.64) d: (2.05 ± 1.07) d, P <0.05]. At 12-month follow-up, the incidence of in-stent restenosis was slightly higher in the two-stent group than in the crossover group, with no significant difference between the MACE and the two groups (P = .43). CONCLUSIONS: Coronary bifurcation lesions with a marginal branch flow reserve score at the critical value are safe and effective for the treatment of crossover of the primary stent.