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The Impact of Side Branch Predilatation on Procedural and Long-term Clinical Outcomes in Coronary Bifurcation Lesions Treated by the Provisional Approach.
MedLine Citation:
PMID:  25017930     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION AND OBJECTIVES: It is uncertain whether side branch predilatation before main vessel stenting is necessary. We evaluated the effect of side branch predilatation on outcomes in percutaneous coronary intervention for true nonleft main bifurcation determined by the Medina classification using the provisional approach.
METHODS: Target vessel failures (composite of cardiac death, myocardial infarction, or target vessel revascularization) were compared between patients who underwent side branch predilatation (predilatation group, n = 175) and those who did not (nonpredilatation group, n = 662).
RESULTS: Final kissing-balloon inflation (57.1% vs 35.8%; P < .001) was performed more frequently and the cross-over rate to a 2-stent technique (14.9% vs 5.1%; P < .001) was higher in the predilatation group. During a median follow-up of 21 months, the predilatation group had a higher incidence of target vessel failures (14.3% vs 6.8%; P = .002) and target vessel revascularization (12.0% vs 5.6%; P = .003), but not of cardiac death or myocardial infarction compared with the nonpredilatation group. On multivariate analysis, side branch predilatation was associated with a higher occurrence of target vessel failures (adjusted hazard ratio = 2.11; 95% confidence interval, 1.27-3.50; P = .004). These results remained consistent after a propensity score-matched population analysis (for target vessel failures, adjusted hazard ratio = 2.63; 95% confidence interval, 1.09-6.34; P = .0031) and they were also constant among the various subgroups, according to the bifurcation angle, calcification, and diameter stenosis of the side branch.
CONCLUSIONS: Side branch predilatation before main vessel stenting may be associated with an increased risk of repeat revascularization in patients with true nonleft main bifurcation treated by the provisional approach. Trial registration: ClinicalTrials.gov number: NCT00851526. Full English text available from: www.revespcardiol.org/en.
Authors:
Pil Sang Song; Young Bin Song; Jeong Hoon Yang; Joo-Yong Hahn; Seung-Hyuk Choi; Jin-Ho Choi; Bon-Kwon Koo; Ki Bae Seung; Seung-Jung Park; Hyeon-Cheol Gwon
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-7-10
Journal Detail:
Title:  Revista espanola de cardiologia     Volume:  -     ISSN:  1579-2242     ISO Abbreviation:  Rev Esp Cardiol     Publication Date:  2014 Jul 
Date Detail:
Created Date:  2014-7-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0404277     Medline TA:  Rev Esp Cardiol     Country:  -    
Other Details:
Languages:  ENG; SPA     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Sociedad Española de Cardiología. Publicado por Elsevier España. All rights reserved.
Vernacular Title:
Efecto en los resultados de la intervención y los resultados clínicos a largo plazo de la predilatación de la rama lateral para lesiones coronarias en bifurcación tratadas con la técnica de stent condicional.
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