Author + information
- Martín Valdebenito1,
- Dante Lindefjeld1,
- Nicolás Veas2,
- José Luis Winter2,
- Manuel Méndez1,
- Osvaldo Pérez1 and
- Alejandro Martínez1
It is not uncommon to find bifurcation lesions in a primary angioplasty (AP) in patients coursing an acute myocardial infarction with ST segment elevation (STEMI). Although the literature supports a simple strategy in patients with stable coronary heart disease and bifurcations, there is little evidence during the AP.
Evaluate the effectiveness and safety of AP in patients with bifurcation lesions in STEMI, comparing a simple strategy (one stent, 1 guide) vs a complex strategy (provisional stent (SP) and / or 2 stents technique).
An observational retrospective cohort analytic study. We searched all STEMI subjected to AP, between January 2012 and June 2014, in the catheterization laboratory of Dr. Sotero del Rio Hospital and were selected patients with bifurcation lesions in the culprit vessel. We reviewed the clinical characteristics, peri- and postprocedural angiographic, and the presence of major adverse cardiac events (MACE; mortality, stroke, reinfarction, revascularization of the culprit vessel) and follow-up mortality. Final angiographic results were compared using a simple strategy (controls) vs complex (cases).
Of a total of 853 patients with STEMI in the period analyzed, 125 (14.6%) had bifurcation lesions in the culprit vessel. Groups (32 cases, 93 controls) were comparable for baseline clinical and angiographic characteristics. In the group of cases was used more contrast (269 mL vs 213 mL; p < 0.05) and radiation (4342 vs 2432 mGy; p <0.05). A better final microvascular flow in the main vessel epicardial measured by TIMI frame count (cTFC) in cases vs controls was obtained (20.8 vs 26.8, p <0.05, cTFC <23 84% vs 49%, p < 0.05). When analyzing subgroups of complex strategy according to the technique of bifurcation (SP and 2 stents) vs the control group (CG), better cTFC was observed in both groups vs the GC (GC SP vs 21 +/- 5.8 vs 26.8 + / - 11.5; p < 0.05; 2 stents vs 20.1 +/- 5 GC vs 26.8 +/- 11.5 p < 0.05), finding no differences between subgroups of patients (SP stents vs 2 vs 21 +/- 5.8 +/- 20.1 5; p = 0.97). There were no differences in MACE (31.2% vs 28.7%; p = 0.83) or overall mortality (6.25 vs 6%; p = 0.2), with a mean of 2.4 years (13-44 months).
Primary angioplasty in bifurcation using a complex strategy vs simple, get better myocardial reperfusion in the main vessel, although more radiation exposure and a slight increase in use of contrast without deterioration of renal function. No differences in the presentation of MACE or follow-up mortality were observed.