Author + information
- Received December 13, 2013
- Revision received April 19, 2014
- Accepted April 23, 2014
- Published online November 1, 2014.
- Shao-Liang Chen, MD∗∗ (, )
- Imad Sheiban, MD†,
- Bo Xu, MBBS‡,
- Nigel Jepson, MD§,
- Chitprapai Paiboon, MD‖,
- Jun-Jie Zhang, PhD¶,
- Fei Ye, MD¶,
- Teugh Sansoto, MD#,
- Tak W. Kwan, MD∗∗,
- Michael Lee, MD††,
- Ya-Ling Han, MD‡‡,
- Shu-Zheng Lv, MD§§,
- Shang-Yu Wen, MD‖‖,
- Qi Zhang, MD¶¶,
- Hai-Chang Wang, MD##,
- Tie-Ming Jiang, MD∗∗∗,
- Yan Wang, MD†††,
- Liang-Long Chen, MD‡‡‡,
- Nai-Liang Tian, MD∗,
- Feng Cao, MD##,
- Chun-Guang Qiu, MD§§§,
- Yao-Jun Zhang, PhD¶ and
- Martin B. Leon, MD‖‖‖
- ∗Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- †San Giovanni Battista Hospital, University of Turin, Turin, Italy
- ‡Beijing Fuwai Cardiovascular Hospital, Beijing, China
- §Hospital of Prince Wales, Sydney, New South Wales, Australia
- ‖Bangkok General Hospital, Bangkok, Thailand
- ¶Nanjing Heart Center, Nanjing, China
- #Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
- ∗∗Mount Sinai Beth Israel, New York, New York
- ††Queen Elizabeth Hospital, Kowloon, Hong Kong
- ‡‡Northern Hospital, Shenyang, China
- §§Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- ‖‖Daqing Oil General Hospital, Daqing, China
- ¶¶Shanghai Ruijin Hospital, Shanghai, China
- ##Xijing Hospital, Xi’an Fourth Military Medical University, Xi’an, China
- ∗∗∗Tianjing Policemen Medical College Hospital, Tianjing, China
- †††Xia’Men Zhongshan Hospital, Xia’Men, China
- ‡‡‡Fujian Union Hospital, Fuzhou, China
- §§§Henan Provincial People’s Hospital, Zhenzhou, China
- ‖‖‖Heart Center, Columbia University, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Shao-Liang Chen, Nanjing First Hospital, Cardiology Department, 68 Changle Road, Nanjing 210006, China.
Objectives The present study established criteria to differentiate simple from complex bifurcation lesions and compared 1-year outcomes stratified by lesion complexity after provisional stenting (PS) and 2-stent techniques using drug-eluting stents.
Background Currently, no criterion can distinguish between simple and complex coronary bifurcation lesions. Comparisons of PS and 2-stent strategies stratified by lesion complexity have also not been reported previously.
Methods Criteria of bifurcation complexity in 1,500 patients were externally tested in another 3,660 true bifurcation lesions after placement of drug-eluting stents. The primary endpoint was the occurrence of a major adverse cardiac event (MACE) at 12 months. The secondary endpoint was the rate of stent thrombosis (ST).
Results Complex (n = 1,108) bifurcation lesions were associated with a higher 1-year rate of MACE (16.8%) compared with simple (n = 2,552) bifurcation lesions (8.9%) (p < 0.001). The in-hospital ST and 1-year target lesion revascularization rates after 2-stent techniques in the simple group (1.0% and 5.6%, respectively) were significantly different from those after PS (0.2% [p = 0.007] and 3.2% [p = 0.009], respectively); however, 1-year MACE rates were not significantly different between the 2 groups. For complex bifurcation lesions, 2-stent techniques had lower rates of 1-year cardiac death (2.8%) and in-hospital MACE (5.0%) compared with PS (5.3%, p = 0.047; 8.4%, p = 0.031).
Conclusions Complex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.
- coronary bifurcation lesion
- drug-eluting stent
- lesion complexity
- major adverse cardiac event
- stent thrombosis
A Nanjing Municipal Healthy Bureau Outstanding Project (NMHBOP-20031280) grant supported the completion of this study. Dr. Chen is a Fellow at the Collaborative Innovation Center for Cardiovascular Disease Translational Medicine of Jiangsu Province, China. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 13, 2013.
- Revision received April 19, 2014.
- Accepted April 23, 2014.
- American College of Cardiology Foundation