Author + information
- Hubertus von Korn1,
- Victor Stefan1,
- Reyn van Ewijk2,
- Kamalesh Chakraborty1,
- Burkhardt Sanwald1,
- Jan Hemker1,
- Ulrich Hink3,
- Marc Ohlow4,
- Bernward Lauer4,
- Silke Kapper1 and
- Thomas Münzel3
Treatment of coronary bifurcation lesions is a complex issue.
This retrospective observational study included patients (pts) who underwent PCI of a de novo coronary bifurcation lesion between January 2008 - August 2011. We included all consecutive patients where the side branch had been covered with a stent. Pts with ACS/cardiogenic shock were not excluded.
Two different methods were compared: group A represented patients undergoing a simple strategy without any treatment of the side branch (SB). Group B consisted of patients where the SB was treated (PCI and/or stenting).
For the treatment of bifurcation lesions we used the concept of “provisional stenting”. Indications for the treatment of the SB included residual stenosis > 50 %, and a TIMI flow reduction < 2.
We performed 1688 PCI during the study period, and of these 138 pts had a bifurcation lesion. We excluded pts with an in-stent-restenosis and pts who had been treated with a drug-coated balloon. The remainder of the population constituted our study group (n= 98) which was divided into group A (n=64, 65.3 %) and group B (n=34, 34.7 %). Mean FU duration was 14.1 (group A) vs 12.3 (group B, p=ns) months.
Mean age (years) was 70.3 yrs (group A) vs. 67.0 yrs (group B, p=ns), 65.6 % were men (group A) vs. 70.6 % (group B, p=ns). NSTEMI/STEMI was present in 54.7 % (group A) vs. 41,2 % (group B, p=ns).
Results: procedural characteristics
Primary stenting was done in 29.7 % (group A) vs. 23.5 % (group B, p=ns), drug-eluting stents were used in 56.3 % (group A) vs. 50.0 % (group B, p=ns). Duration of x-raying (min, group A vs group B) and the amount of contrast medium (ml) were both significantly lower in group A: 18.1 min vs 20.1 min and 225.8 ml vs 307.4 ml (p=0.02 and p < 0.001, respectively).
Final TIMI flow III inside the MB was reached in 98.4 % (group A) vs. 97.1 % (group B, p=ns), while inside the SB it was reached in 84.4 % vs. 94.1 % (p= ns, group A vs group B).
Target lesion revascularization (TLR: Re-PCI of the lesion, definite stent thrombosis or CABG related to the target lesion) and target vessel revascularization (TVR) was seen in 15.9 % (group A) vs 32.4 % (group B, p=0.07), while cardiac death was observed in 7.9 % (group A) vs 14.7 % (group B, p=0.3). A survey of all MACE in both groups (TLR plus TVR plus cardiac death) revealed the following distributions: 23.8 % (group A) vs. 47.1 % (group B, p=0.02).
In patients with coronary bifurcation lesions, a simpler strategy without SB-PCI has a significantly lower MACE rate.
- 2013 American College of Cardiology Foundation