| Research objective Objective To investigate the diameter relationship between main branch and side branch of coronary bifurcation in the coronary angiography and PCI so as to put forward a new classification method----diameter classification system. To evaluate the specific operation for every type guided from the diameter classification method and recommend the best interventional treatment for different types.Research method 1. 361 patients with 1080 bifurcation lesions or bifurcated coronary arteries in five heart centers including Beijing military region general hospital, Beijing anzhen hospital, tianjin fifth central hospital, the first people’s hospital and luxin hospital in shandong province underwent Coronary angiography or PCI from March 2011 to April 2015. We measured the diameter of proximal main branch(Dp), the distal main branch(Dd) and the side branch(Ds). All above 2.5 mm of the diameter were written down to observe the relationship and its occurrence frequency. According to the frequency, we divided into four types, type 1(ZJ1) : Dp = Dd > Ds; type 2(ZJ2) : Dp = Dd = Ds; type 3(ZJ3) : Dp = Dd and Dd + Ds = Ds; type 4(ZJ4): do not meet any types above.2. 189 patients with bifurcation lesions in five heart centers including Beijing military region general hospital, Beijing anzhen hospital, tianjin fifth central hospital, the first people’s hospital and luxin hospital in shandong province underwent Coronary angiography and PCI from April 2011 to April 2016. They were all given two-stent strategy. ZJ1 were given DK mini- Crush stent strategy, ZJ2 were given DK mini-Culotte stent strategy, ZJ3 were given SKS/V stent strategy. Observe the incidence of major adverse cardiac events after 1 month and 1 year, including mortality, the recurrence rate of myocardial infarction, the incidence of stent thrombosis and stent restenosis.Results 1. 361 patients with 1080 bifurcation lesions or bifurcated coronary arteries were divided into four types according to the diameter classification system.ZJ1 concluded 469 and accounted for 43.4%. ZJ2 concluded 305 and accounted for 28.2%. ZJ3 concluded 248 and accounted for 23%. ZJ4 concluded 58 and accounted for 5.4%.2. The success rate was 100% of three groups. The incidence of heart attacks of three groups after 1 month were12.6%, 5.4% and 12.7% respectively. The fatality rates were 2.3%, 0% and 2.1%. The myocardial infarction recurrence rates were 4.6%, 3.6% and 6.4%. The incidences of stent thrombosis were 3.4%, 0% and 2.1%. The stent restenosis rates were2.3%, 1.8% and 2.1%. The incidences of heart attacks of two groups after 1 year were 28.7%, 23.6% and 23.4% respectively. The fatality rates were 8.0%, 9.1% and 6.4%. The myocardial infarction recurrence rates were 10.3%, 7.3% and 8.5%. The incidences of stent thrombosis were 4.6%, 3.6% and 4.3%. The stent restenosis rates were 5.7%, 3.6% and 4.3%.Conclusion ⑴This study summarizes a new classification method- diameter classification system through the observation and record of the diameter relationship between the main branch and side branch. This classification method is simple, intuitive and easy to remember. It can give the PCI doctors a new inspiration and reference in the clinical practice. ⑵Diameter classification method is important in the selection of treatment technology for coronary bifurcation lesions. It ties closely between classification and the choice of operation. The incidence of heart attacks is low. It is of great significance in the interventional therapy for bifurcation lesions. |
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