CAJ | 학술논문

目的：建立预测冠状动脉(冠脉）分叉病变介入治疗中分支闭塞风险模型及评分系统。方法：本研究对我院2012-01至2012-07连续7007例经皮冠脉介入治疗（PCI）患者进行筛选，入选以单支架或临时性双支架策略行PCI的分叉病变患者1545例（共计1601处病变）。根据术中是否发生分支闭塞分为无分支闭塞组（n=1431例）和分支闭塞组（n=114例）。按时间顺序将1601处病变中前1200处作为建模数据集用于构建介入治疗中分支闭塞风险模型和评分系统，将后401处作为验证数据集进行验证。结果：建模数据集分析显示，术前主支血管斑块与分支血管位置关系、支架置入前主支血管心肌梗死溶栓治疗临床试验（TIMI ）血流等级、术前分叉核直径狭窄程度、术前分叉角度、支架置入前分支直径狭窄程度和术前主支/分支血管直径比是分支闭塞的独立危险因素，风险模型的ROC曲线下面积0.80[95%可信区间（CI）：0.75~0.85]， Hosmer-Lemeshow法（HL）P=1.00；评分系统ROC曲线下面积0.76（95%CI：0.71~0.82），HL P=0.12。验证数据集检验风险模型的ROC曲线下面积0.81（95%CI：0.73~0.89），HL P=0.77；评分系统ROC曲线下面积0.77（95%CI：0.69~0.86）， HL P=0.58。建模数据集和验证数据集患者评分系统积分四分位数划分结果显示评分积分≥10分患者分支闭塞发生率明显高于10分以下患者（ P<0.001），术中分支闭塞风险高。结论：本研究建立的评分系统简便易用，通过定量分析冠脉造影区分出分叉病变介入治疗中分支闭塞高风险患者。
목적：건립예측관상동맥(관맥）분차병변개입치료중분지폐새풍험모형급평분계통。방법：본연구대아원2012-01지2012-07련속7007례경피관맥개입치료（PCI）환자진행사선，입선이단지가혹림시성쌍지가책략행PCI적분차병변환자1545례（공계1601처병변）。근거술중시부발생분지폐새분위무분지폐새조（n=1431례）화분지폐새조（n=114례）。안시간순서장1601처병변중전1200처작위건모수거집용우구건개입치료중분지폐새풍험모형화평분계통，장후401처작위험증수거집진행험증。결과：건모수거집분석현시，술전주지혈관반괴여분지혈관위치관계、지가치입전주지혈관심기경사용전치료림상시험（TIMI ）혈류등급、술전분차핵직경협착정도、술전분차각도、지가치입전분지직경협착정도화술전주지/분지혈관직경비시분지폐새적독립위험인소，풍험모형적ROC곡선하면적0.80[95%가신구간（CI）：0.75~0.85]， Hosmer-Lemeshow법（HL）P=1.00；평분계통ROC곡선하면적0.76（95%CI：0.71~0.82），HL P=0.12。험증수거집검험풍험모형적ROC곡선하면적0.81（95%CI：0.73~0.89），HL P=0.77；평분계통ROC곡선하면적0.77（95%CI：0.69~0.86）， HL P=0.58。건모수거집화험증수거집환자평분계통적분사분위수화분결과현시평분적분≥10분환자분지폐새발생솔명현고우10분이하환자（ P<0.001），술중분지폐새풍험고。결론：본연구건립적평분계통간편역용，통과정량분석관맥조영구분출분차병변개입치료중분지폐새고풍험환자。
Objective: To establish a risk prediction model and scoring system in patients with side branch (SB) occlusion during coronary bifurcation intervention. Methods: A total of 7007 consecutive patients who received percutanenous coronary intervention (PCI) in our hospital from 2012-02 to 2012-07 were recruited and 1545 patients (with 1601 bifurcation lesions) treated by single stent technique or main vessel stenting ifrst strategy were selected for our study. According to weather SB occlusion occurred during operation, the lesions were divided into 2 groups: Non-SB occlusion group,n=1431 and SB occlusion group,n=114. The data set of the ifrst 1200/1601 lesions by time sequence, was used for establishing the risk model and scoring system, the data set of rest 401 lesions was used for model validation. Results: The modeling data set presented that the relationship between pre-operative main vessel plaque and the position of branch vessel, the main blood vessel pre-stenting TIMI grade, the stenosis degree of pre-operative bifurcation nucleus, the angle of pre-operative bifurcation and the ratio of pre-senting stenosis degree of branch diameter and pre-operative main vessel to branch vessel diameter were the independent risk factors for branch occlusion. The risk model ROC=0.80, 95% CI 0.75-0.85, Hosmer-Lemeshow HLP=1.00; the scoring system ROC=0.76, 95% CI 0.71-0.82, HLP=0.12. The validation data set ROC=0.81, 95% CI 0.73-0.89, HLP=0.77; the scoring system ROC=0.77, 95% CI 0.69-0.86, HLP=0.58. The quartile integration of both data sets indicated that the patients with the integration score ≥ 10 had the higher risk for SB occlusion than those with integration score < 10 during the operation,P<0.001. Conclusion: Our research developed a simple and user-friendly system, it may distinguish the patients with high risk of SB occlusion during bifurcation intervention by quantitative stratiifcation of coronary angiographic imaging.