“Provisional”支架策略处理无保护左主干分叉病变3年的临床结果
Provisional stent strategy for the treatment of unprotected left main bifurcation lesions: 3-year clinical outcomes

邱茹洁.“Provisional”支架策略处理无保护左主干分叉病变3年的临床结果[J].内科急危重症杂志,2026,32(2):153-156

DOI：10.11768/nkjwzzzz20260210

中文关键词: 无保护左主干真性分叉病变单支架双支架急性非ST段抬高型心肌梗死

英文关键词:

基金项目:

作者	单位	E-mail
邱茹洁		xuchengyi_yaxin@aliyun.com

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中文摘要:

摘要目的：评估“Provisional”支架策略或双支架策略治疗高危非ST段抬高型急性心肌梗死（NSTEMI）合并无保护左主干（ULMCA）分叉病变患者的长期临床结果。方法：单中心、回顾性分析接受早期经皮冠状动脉介入术（PCI）治疗的高危NSTEMI合并罪犯血管为ULMCA真性分叉病变（Medina 1,1,1、Medina 0,1,1）458例患者的临床和介入相关数据。依据支架置入策略分为“Provisional”单支架组（272例）和双支架组（186例）。主要终点为靶病变失败（TLF）。采用Kaplan meier法比较2组患者PCI术后3年随访TLF的生存时间。对单变量分析中所有显著的变量和被认为具有临床重要性的变量进行多变量回归分析。结果：3年随访，单支架组TLF事件显著低于双支架组（9.3% vs. 20.8%，P=0.002），Kaplan meier生存曲线在18个月随访时明显分离。Logistic回归分析显示，校正混杂因素后支架置入策略与TLF相关，“Provisional”单支架策略能有效降低高危NSTEMI合并ULMCA真性分叉病变患者PCI术后3年TLF事件发生率（OR=1.89，95%CI:0.69~3.01，P=0.03）。结论：“Provisional”单支架策略处理高危NSTEMI合并ULMCA真性分叉病变的长期TLF发生率均较低，且优于双支架策略。

英文摘要:

Abstract Objective: To evaluate the long-term clinical outcomes of the "Provisional" single or dual stent strategy for the treatment of patients with non-ST segment elevation acute myocardial infarction (NSTEMI) combined with unprotected left main coronary artery (ULMCA) bifurcation lesions. Methods: A single center, retrospective analysis, continuous analysis was conducted on the clinical and interventional data of high-risk NSTEMI patients with ULMCA true bifurcation lesions (Medina 1,1,1; Medina 0,1,1) who underwent early PCI treatment. Totally, 458 patients met the study inclusion and exclusion criteria, they were divided into a "Provisional" single stent group (272 cases ) and a dual stent group (186 cases) according to the stent implantation strategy. The primary endpoint was target lesion failure (TLF). Kaplan Meier method was used to compare the survival time of two groups of patients with TLF at 3-year follow-up after PCI. The multivariate regression analysis was performed on all significant variables and clinically important variables in univariate analysis. Results: For 3-year follow-up, the TLF events in the single stent group were significantly lower than those in the dual stent group (9.3% vs. 20.8%, P=0.002), and the Kaplan-meier survival curve showed significant separation at 18-month of follow-up. Logistic regression analysis showed that, after adjusting for confounding factors, the stent implantation strategy was associated with TLF. The "Provisional" single stent strategy effectively reduced the incidence of TLF events at 3-year follow-up after PCI in high-risk NSTEMI patients with ULMCA true bifurcation lesions (OR 1.89, 95%CI 0.69-3.01, P=0.03). Conclusions: The long-term incidence of TLF for the treatment of high-risk NSTEMI complicated with ULMCA bifurcation lesions using the "Provisional" single stent strategy was lower and superior to the dual stent strategy.