[TCT2008]BBC ONE研究提示：分叉病变患者支架治疗——越简单越好

发布于:2008-10-21 09:19

BBC ONE研究显示，对于大多数分叉病变，简单支架策略优于复杂策略。采用provisional T支架术不仅是手术时间增加而且术后9个月MACE率也比较高。David Hildick-Smith在TCT 2008会议上汇报了这一结果。

BBC ONE试验选取500例分叉病变患者，随机分成简单策略组（n=250例，只在主支置入支架并对吻扩张，或用T支架技术必要时分支置入支架）和复杂策略组（n=250例，由术者决定采用culotte还是Crush技术）。

9个月随访发现：简单策略组在主要联合终点死亡、MI以及TVF上具有明显优势(8.0% vs. 15.2%; P=0.009)，单个终点MI率，简单策略组也比较低(3.6% vs. 11.2%; P=0.001)，且在TVR和死亡率上也占据优势，但未达统计学意义。MACE在复杂策略组明显升高 (7.6% vs. 2.0%, RR 3.8, 95% CI, 1.5-10.0, P = 0.003)。

两组患者的基线特征相同，并且82%的患者病变集中在前降支，第一对角支，83%属于真分叉病变，10%的患者有中度或者以上的钙化，支架长度在复杂策略组明显要长(41 mm vs. 24 mm; P<0.0001)。

简单策略也非完美
Hildick-Smith 总结说“虽然这项研究提示：对于大多数患者T stent优于复杂策略，但是并未说明简单策略是处理所有分叉病变的最好方法。我们要考虑到是否所有的亚型，简单策略是否都能适用。”

Antonio Colombo教授指出：BBC ONE提供的信息很重要，具有非常重要的现实意义，如果没有必要，我们就不要把简单问题复杂化，如果边支没有那么重要，最好的处理措施就是不要处理。但这也并未否定当病变累及超过大的边支血管开口有需置入2个或者更多支架的必要。毕竟，不能简单时，我们只能复杂处理。

（医心评论：马秀芹译呼唤校）

（来源：www.tctmd.com）

BBC ONE: In Bifurcation Stenting, Keep It Simple

For unselected bifurcation lesions, a simple stenting strategy with drug-eluting stents (DES) is superior to a complex strategy, according to results from the BBC ONE trial, which were presented Thursday, October 16, at TCT 2008.
David Hildick-Smith, MD, of the Sussex Cardiac Center (Brighton, UK), presented data from the BBC ONE (British Bifurcation Coronary study: Old, New and Evolving strategies) late-breaking trial, which showed that a provisional T-stenting strategy improved procedure times and 9-month major adverse cardiac event (MACE) rates .

BBC ONE randomized 500 patients with bifurcation lesions to either a simple strategy involving main-vessel DES implantation with kissing inflation and T-stenting and provisional side-branch stenting (n=250) or a complex strategy involving total lesion coverage with either culotte or crush techniques (n=250) according to operator preference.
At 9-month follow-up, the primary composite endpoint of death, myocardial infarction (MI), or target vessel failure (TVF) showed a significant advantage for the simple strategy (8.0% vs. 15.2%; P=0.009). Analysis of individual endpoints demonstrated a lower rate of MI with the simple strategy (3.6% vs. 11.2%; P=0.001). Rates of TVR and death were also lower with the simple strategy, but the differnces were not statistcally significant.

Periprocedural MACE was substantially higher in the complex strategy (7.6% vs. 2.0%, RR 3.8, 95% CI, 1.5-10.0, P = 0.003), and procedural endpoints demonstrated improved times and better resource utilization with the simple strategy
Baseline characteristics were similar between the groups, and 82% of patients had the bifurcation lesion at the left anterior descending artery, first diagonal. A true bifurcation was observed in about 83%, and approximately 10% had at least moderate calcification. The average total stented length was significantly higher in the complex strategy group (41 mm vs. 24 mm; P<0.0001).

Simple Strategy Still Not Necessarily Best Strategy
"In this study for a largely unselected group of bifurcation lesions, a stepwise provisional T stenting strategy proved to be superior to a systematic complex strategy in all of the domains represented here," Dr. Hildick-Smith concluded, adding, "It’s worth pointing out that the message [of this study] is not that the simple strategy is necessarily the appropriate strategy for all bifurcations."

"That’s not a conclusion that can be reached from this study. It is important that we think first about whether there are bifurcation subsets in which total lesion coverage may yet be advantageous," he stressed.

Antonio Colombo, MD, of the San Raffaele Hospital (Milan, Italy), commented on the BBC ONE presentation, noting that it is a "very important, very practical, and useful study with regard to our everyday practice."

Dr. Colombo’s interpretation was in line with Dr. Hildick-Smith’s. "We should keep the procedure simple if there is no need to make it complex. When the side branch is not so important, the best approach is to end the procedure with the side branch still open," he said.

But, Dr. Colombo added, "Unfortunately, these findings do not mean that 2 or more stents will not be needed when dealing with larger side branches with disease extending beyond the ostium（口）. Sometimes when you cannot be simple, you need to be complex."

来源：医心网

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