CAJ | 학술논문

目的：探讨冠状动脉分叉病变介入治疗中小分支闭塞导致的围术期心肌损伤的发生率及其预测因素。 　　方法：连续入选925例经皮冠状动脉介入治疗（PCI）的患者，共包括949个分叉病变[冠状动脉造影定量分析（QCA）测量分支直径≤2.0 mm]，根据分叉病变是否发生了小分支闭塞分为小分支闭塞组（85例，86个分叉病变）和小分支未闭塞组（840例，863个分叉病变）。收集所有入选患者的临床特征、冠状动脉造影及PCI术中的情况、QCA的数据。采用多元回归分析来确定小分支闭塞的独立预测因素。比较小分支闭塞组和小分支未闭塞组的围术期心肌损伤的发生率。 　　结果：949个分叉病变中共有86个（9.1%）分叉病变发生了小分支闭塞,小分支闭塞组围术期心肌损伤的发生率（26/83,31.3%）明显高于小分支未闭塞组（77/821,9.4%；P<0.001），围术期心肌梗死的发生率（6/83,7.2%）也显著高于小分支未闭塞组（11/821,1.3%；P<0.001）。两组间主支近段、主支远段、小分支、分叉核心的血管直径及狭窄程度差异均有统计学意义。主支/小分支直径比值小分支闭塞组明显大于小分支未闭塞组（P<0.001），差异有统计学意义。小分支闭塞的独立预测因素包括真分叉病变、斑块不规则、预扩张小分支、术前小分支心肌梗死溶栓治疗临床试验（TIMI）血流分级、术前主支远端的狭窄程度、术前分叉病变核心的狭窄程度、分叉病变角度、主支/小分支直径比值、主支支架置入前小分支狭窄程度。 　　结论：小分支闭塞的患者围术期心肌损伤的发生率明显增高,部分病变特征与小分叉病变闭塞有关。
목적：탐토관상동맥분차병변개입치료중소분지폐새도치적위술기심기손상적발생솔급기예측인소。 　　방법：련속입선925례경피관상동맥개입치료（PCI）적환자，공포괄949개분차병변[관상동맥조영정량분석（QCA）측량분지직경≤2.0 mm]，근거분차병변시부발생료소분지폐새분위소분지폐새조（85례，86개분차병변）화소분지미폐새조（840례，863개분차병변）。수집소유입선환자적림상특정、관상동맥조영급PCI술중적정황、QCA적수거。채용다원회귀분석래학정소분지폐새적독립예측인소。비교소분지폐새조화소분지미폐새조적위술기심기손상적발생솔。 　　결과：949개분차병변중공유86개（9.1%）분차병변발생료소분지폐새,소분지폐새조위술기심기손상적발생솔（26/83,31.3%）명현고우소분지미폐새조（77/821,9.4%；P<0.001），위술기심기경사적발생솔（6/83,7.2%）야현저고우소분지미폐새조（11/821,1.3%；P<0.001）。량조간주지근단、주지원단、소분지、분차핵심적혈관직경급협착정도차이균유통계학의의。주지/소분지직경비치소분지폐새조명현대우소분지미폐새조（P<0.001），차이유통계학의의。소분지폐새적독립예측인소포괄진분차병변、반괴불규칙、예확장소분지、술전소분지심기경사용전치료림상시험（TIMI）혈류분급、술전주지원단적협착정도、술전분차병변핵심적협착정도、분차병변각도、주지/소분지직경비치、주지지가치입전소분지협착정도。 　　결론：소분지폐새적환자위술기심기손상적발생솔명현증고,부분병변특정여소분차병변폐새유관。
Objective: To investigate the prognostic factor for small side branch (SB) occlusion during coronary bifurcation intervention with the incidence rate of peri-procedural myocardial injury (PMI) in relevant patients. Methods: A total of 925 consecutive patients who received coronary bifurcation intervention were enrolled and there were 949 SB lesions ≤ 2.0 mm conifrmed by quantitative coronary angiography (QCA). The patients were divided into 2 groups: SB occlusion group,n=85, including 86 bifurcation lesions and Non-SB occlusion group,n=840, including 863 bifurcation lesions. The clinical characteristics, QCA findings and PCI procedural conditions were studied by Multivariate logistic regression analyses to explore the independent predictors of SB occlusion and to compare the incidence rate of PMI. Results: The total SB occlusion rate was 9.1% (86/949). SB occlusion group had the higher incidence rate of PMI (26/83, 31.3%) vs (77/821, 9.4%) and peri-operative MI mortality(6/83, 7.2%) vs (11/821, 1.3%) than Non-SB occlusion group, both P<0.001. In SB occlusion group, the diameter ratio of main vessel (MV)/SB was obviously higher than Non-SB occlusion group,P<0.001. The independent predictors of SB occlusion included in true bifurcation lesion, irregular plaque, pre-dilation of SB, TIMI lfow grade of pre-procedural SB, stenosis degrees of distal MV and bifurcation core, bifurcation angle, diameter ratio of MV/SB and the stenosis degree of SB before MV stenting. Conclusion: Coronary bifurcation lesion patients with SB occlusion had the higher risk of PMI during the interventional procedure.