论文部分内容阅读
Background Stenting strategies and clinical outcomes of bifurcation lesions in a chronic total occlusion (CTO) vessel after successful recanalization remain to be unknown.Methods Between January 2001 and December 2009,195 (41.1％) patients with 254 (47.0％) bifurcation lesions in CTO vessels from a pool of 564 patients with 659 CTO lesions were included and divided into proximal (n=134) and distal (n=120) groups,according to the location of the bifurcation lesions.The primary endpoint was the occurrence of major adverse cardiac events (MACE) at the end of clinical follow-up,including cardiac death,myocardial infarction,or target vessel revascularization (TVR).Results Collaterals with Rentrop class 3 were seen more in distal group (100％ and 68.3％),compared to proximal group (76.9％ and 45.6％).Two-stent technique for proximal bifurcation lesions was used in 24.6％,significantly different from the distal group (6.7％,P ＜0.001),without significant difference in composite MACE between proximal and distal groups,or between one- and two-stent subgroups in proximal group.The composite MACE after 1-year in complete revascularization subgroup was 17.9％ relative to 29.6％ in the incomplete revascularization group (P=-0.044).Stents in long false lumen in main vessel were mainly attributive to decreased TIMI grade flow,with resultant increased in-stent restenosis,total occlusion,TVR and coronary aneurysms.Imcomplete revasculzarization (HR 2.028,P=0.049,95％ CI 1.002-4.105) and post-stenting TIMI flow (HR 6.122,P=0.020,95％ CI 1.334-28.092) were two independent predictors of composite MACE at the 1-year follow-up.Conclusions Two-stent was more used for proximal bifurcation lesions.No significant difference was observed in MACE between proximal and distal,or between one- and two-stent subgroups in the proximal group.Placement of a safety wire was critical for proximal bifurcation lesions.Complete revascularization was mandatory to improve clinical outcomes.