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Bifurcation (BF) lesions remain a challenging lesion and often associated with lower success rates. The aim of this study is to evaluate the impact BF intervention in acute myocardial infarction (AMI) on the angiographic and clinical outcomes of Asian population.
A total of 903 patients (pts) were underwent percutaneous coronary intervention (PCI) for AMI between January 2004 and April 2009. Patients were divided into two groups according to presence of a BF lesion in the infarct-related artery: BF group (n= 332) and non BF group (n=571). BF lesions were defined if a side branch (SB) diameter was ≥2.0 mm.
BF group had more male gender, higher incidence of non ST elevation MI(NSTEMI, 51.5% vs. 60.4%, p=0.01), higher incidences of culprit lesion in left anterior descending artery, left circumflex artery, and left main as compared with non BF group. However, the level of peak values of cardiac enzyme and left ventricular ejection (LVEF) were similar between the two groups. The six months angiographic outcomes and the cumulative clinical outcomes up to two years including total death, cardiac death, MI, and major adverse cardiac events (MACE) were similar between the two groups. However, BF group had higher incidence of target lesion revascularization (TLR), target vessel revascularization (TVR) and TVR-MACEs as compared with non BF group (Table).
Despite BF intervention in AMI is challenging, the six months angiographic outcomes and 2 years clinical outcomes were similar between the two groups. However, BF intervention in AMI had higher incidence of repeat revascularization.
|Variable, n (%)||Bifurcation (N=332)||Non BF (N=571)||P value|
|Total Death (TD)||24 (9.6)||49 (11.0)||0.608|
|Cardiac death (CD)||22 (8.8)||35 (7.9)||0.774|
|Recurrent MI||13 (5.2)||13 (2.9)||0.146|
|STEMI||9 (3.6)||9 (2.0)||0.221|
|TLR (target lesion revascularization)||36 (14.4)||29 (6.5)||0.001|
|TVR(target vessel revascularization)||41 (16.4)||40 (9.0)||0.004|
|TLR MACE (CD+STEMI+TLR)||57 (22.8)||63 (14.2)||0.005|
|All MACE (TD +MI +TLR+TVR)||66 (26.4)||97 (21.8)||0.192|