Study of diameter classification system and its guidance for PCI of coronary bifurcation lesions
WANG Guan-nan
ZHANG Jian
SHI Yu-jie
LI Jun-xia
Abstract：Objective To investigate the diameter relationship between main branch and side branch of coronary bifurcation to put forward a new classification method——diameter classification system, then use the method to guide operation selection and evaluate treatment effect.Methods 361 patients with 1080 bifurcation lesions or bifurcated coronary arteries from five heart centers in north of China including Beijing military region general hospital, were selected from March 2011 to April 2015. The diameter of proximal main branch (Dp), the distal main branch (Dd) and the side branch (Ds) were measured during operation. All of main branch and side branch of coronary bifurcation with diameter over 2.5 mm were recorded. According to relationship and frequency among Dp, Dd and Ds, patients were divided into four groups, 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. 189 patients with bifurcation lesions 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. Incidence rates of major adverse cardiac events, including mortality, myocardial infarction relapse rate, the incidence rates of coronary stent thrombosis and in-stent restenosis were observed at 1 month and 1 year after operation.Results 361 patients with 1080 bifurcation lesions or bifurcated coronary arteries were divided into four types according to the diameter classification system:469 lesion of ZJ1 (43.4%), 305 lesion of ZJ2 (28.2%),248 lesion of ZJ3 (23%) and 58 lesion of ZJ4 (5.4%). 189 patients received operation with 100% succeeded. 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 The new classification system is simple, intuitive, high maneuverability and lower incidence of heart attacks. It is of great significance in the interventional therapy for bifurcation lesions.
Keywords：Coronary bifurcation lesionsPercutaneous coronary interventionDiameter classification systemCoronary angiography
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 403-407 )