| Objective:The preoperative and intraoperative coronary angiographic data of patients with coronary bifurcation lesions were scored using the V-RESOLVE scoring system,in which the V-RESOLVE score≥12 was assigned to high-risk populations with branch occlusion.According to whether or not the intraoperative branch was implanted with stent,the surgical strategies were divided into simple strategies（single stent group）and complex strategies（double stent group）,the selected conditions of intervention strategies were counted for high-risk populations with branch occlusion,collected relevant parameters of interventional surgery in two groups of patients,and the cardiovascular events were followed up.The reliability of the V-RESOLVE scoring system for the prediction of branch occlusion risk in coronary artery bifurcation lesions was examined.The superiority and inferiority of the two surgical strategies in the high-branch occlusion risk group were compared to provide a reference for the choosing of treatment strategies for bifurcation lesions.Objects and methods:1.Serially selected patients who were showed with bifurcation lesions by coronary angiography and treated with coronary intervention from July 2015to February 2017 in the Armed Police College Affiliated Hospital.Analyzed the patient’s clinical features,coronary angiography results,and interventional procedures.V-RESOLVE scoring system was used to score the relevant parameters of preoperative and intraoperative coronary angiography data and the patients with non-left main bifurcation lesions whose V-RESOLVE score≥12 were selected as study subjects.2.Patients were divided into simple strategy group and complex strategy group according to the situation of stent implantation during the operation.At the same time,we observed the branch occlusion rate after the stenting of the main artery in the two groups(defined as myocardial infarction thrombolytic therapy Trial（TIMI）flow grade decrease or no reflow[8].All selected patients were followed up for 12 months.Major adverse cardiac events（MACE）（including cardiac death,myocardial infarction,target vessel revascularization,and stent thrombosis）were collected during hospitalization and follow-up in both groups.3.Statistical analysis using SPSS software,with P<0.05 was considered significant difference.The incidence of branch occlusion was calculated for all patients.Coronary angiography related parameters before and after surgery,and the occurrence of MACE events during hospitalization and follow-up were compared between the two groups.Result:1.A total of 88 patients were enrolled in this study.There were 57 male patients and 31 female patients.The average age was 62.14±8.33 years.Among them,there are 60 simple strategy groups and 28 complex strategy groups.There was no significant difference in clinical baseline data such as gender,age,smoking history,hypertension,diabetes,cerebrovascular disease,heart failure,and hyperlipidemia between the two groups（P>0.05）;2.Comparison of clinical biochemical indicators and echocardiography results:Compared with simple strategies and complex strategies,there were no statistical differences in biochemical indicators（P>0.05）,such as blood lipid levels,urea nitrogen,creatinine,uric acid,fasting blood glucose,glycated hemoglobin,and homocysteine in both groups.In terms of echocardiography,there was no significant difference in left ventricular ejection fraction between the two groups（56.93±7.44%vs 58.25±7.72%,P=0.447）;3.Preoperative and intraoperative coronary angiography results analysis:analysis of coronary angiography data showed that there was no statistical difference in the compositional ratio of the lesion site（anterior descending branch-diagonal branch bifurcation,circumflex-obtuse marginal branch,right posterior trigeminal lesions）in the two groups of patients（P=0.941）.Comparing the classification of lesions,there was no statistical difference in the composition ratio of Medina subtypes between the two groups（P=0.599）.In the complex strategy group,the preoperative length of the main branches andbrancheswerelonger（20.61±3.25mmvs15.34±2.34mm,P=0.000;10.70±2.37mmvs8.48±1.93mm,P=0.000）,and the degree of branch stenosis was more severe（75.46±6.58%vs 67.14±8.13%,P=0.000）.In the V-RESOLOVE score composition,the major branch/branch diameters ratio in the complex strategy group were more in the 1.0-1.5 group（67.9%vs 38.3%,P=0.033）.There was no statistical difference of the V-RESOLOVE scores for the two groups of patients（15.72±2.03vs15.54±2.74,P=0.729）;4.Comparison of interventional treatment:60 patients in the simple strategy group were received stent plus branch guidewire/balloon protection or balloon dilatation,and 28 patients in complex strategy group.All patients underwent double stent implantation.A total of 15 patients suffered from branch occlusion after stenting in the main branch.There were 2 cases in the double-stent group,both of which were scheduled for single-stent implantation before surgery.Due to a decrease in TIMI blood flow during surgery,the strategy was changed to double stenting,the total incidence of branch occlusion was 17.05%.Comparing the initial simple strategy group with the initial complex strategy group,there was a statistically significant difference in the incidence of branch occlusion between the two groups（25.0%vs 0.0%,P=0.009）;5.Comparison between simple strategy group and complex strategy group:There is no difference in clinical baseline data between the two groups of patients.Immediate effect of surgery:There is no difference between the two groups of patients with lumen immediate access to the main branch vessels and postoperative residual stenosis（P>0.05）.For the branch vessels,the preoperative minimal lumen diameter（MLD）of the complex strategy group was smaller（0.56±0.16 vs 0.66±0.17,P=0.012）,and the lumen immediate access after surgery was more（1.30±0.19 vs 0.51±0.20,P=0.000）,the lumen stenosis after surgery improved more（56.04±6.96%vs24.18±8.67%,P=0.000）,which was significantly better than that of the single stent group;6.The incidence of MACE events during hospitalization and follow-up was compared between the two groups of patients.There was no statistical difference in the incidence of MACE events during hospitalization and follow-up（P>0.05）.There was no significant difference in the event-free survival rate between the two groups（P=0.579）.Conclusion:1.Coronary bifurcation lesions with a V-RESOLVE score≥12 belong to the high-risk group with branch occlusion.The rate of branch occlusion reported in the literature is 16.7%,which is approximately the same as the incidence of branch vessel occlusion in the patients enrolled in this trial.The V-RESOLVE scoring system can predict the risk of branch occlusion well,and screen out the high-risk crowds with branch occlusion;2.For patients with coronary artery bifurcation lesions with a V-RESO LVE score of≥12,compared with the single-stent strategy,branch vessels in the double-stent group gained more lumen diameter,and lumen stenosis improved more after surgery.There was no statistical difference in internal thrombosis and adverse cardiac events（MACE）between two groups;3.Compared with the complex strategy,the simple strategy group has a higher probability of branch occlusion and predicts a greater surgical risk.For these patients,the double-stent strategy may be a better choice. |
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