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2-Year Outcome of Patients Treated for Bifurcation Coronary Disease With Provisional Side Branch T-Stenting Using Drug-Eluting Stents

ICPS Institut Cardiovasculaire, Paris Sud, Massy, France.

^_* Reprint requests and correspondence: Dr. Marie-Claude Morice, ICPS Institut Cardiovasculaire, Paris Sud, Institut Hospitalier Jacques Cartier, 6 Avenue du Noyer Lambert, Massy, France. (Email: mc.morice{at}icps.com.fr).

Objectives: Our goal was to determine whether the deployment of drug-eluting stents (DES) in bifurcation lesions, according to a uniform provisional side-branch T-stenting strategy (PTS), is a safe and effective treatment in the immediate and long term.

Background: In comparison with simple stenoses, successful percutaneous intervention for coronary bifurcation lesions is limited by a higher incidence of procedural complications and need for repeat revascularization. The ideal strategy to overcome these limitations remains to be demonstrated while recent controversy surrounds the long-term safety of DES in bifurcations.

Methods: Consecutive patients treated for bifurcation lesions using DES were studied in a prospective single-center registry. Between 2003 to 2005, 477 procedures were performed. The PTS strategy was used in 92%, with a side-branch stent in 28% and final kissing balloon inflation in 95%.

Results: Angiographic success was achieved in 99% with 2.5% in-hospital major adverse cardiac events. The cumulative rate of major adverse cardiac events was 10.7% at 1 year and 13.6% at 2 years, including 6.9% and 8.9% target vessel revascularization. Deviation from the PTS strategy independently predicted 2-year mortality (odds ratio: 5.5 [95% confidence interval: 1.63 to 18.3], p < 0.01). The rate of definite or probable stent thrombosis at 2 years was 2.5% with half of all events occurring before hospital discharge.

Conclusions: The PTS strategy for the treatment of bifurcation lesions is applicable to over 90% of patients in the real world. With DES, both safety and efficacy have been demonstrated in the long-term with <10% need for repeat revascularization in the first 2 years and a low incidence of late stent thrombosis.

Key Words: angioplasty • bifurcation lesions • drug-eluting stents • stent thrombosis

Abbreviations and Acronyms   BMS = bare-metal stent(s)   CI = confidence interval   CK = creatine kinase   DES = drug-eluting stent(s)   MACE = major adverse cardiac events   MI = myocardial infarction   MV = main vessel   PCI = percutaneous coronary intervention   PTS = provisional T-stenting   SB = side branch   STEMI = ST-segment elevation myocardial infarction   TLR = target lesion revascularization   TVR = target vessel revascularization

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