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Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations.
MedLine Citation:
PMID:  23141875     Owner:  NLM     Status:  Publisher    
BACKGROUND: The crush and culotte are probably the most common two-stent techniques utilized for percutaneous coronary intervention (PCI) of complex bifurcation lesions. Long-term outcome associated with the utilization of these techniques is unknown. Our objective was to evaluate the long-term outcomes after bifurcation PCI utilizing these 2 techniques with a prospective PCI registry. METHODS: Between 11/1/2003 and 12/31/2007, 360 patients were treated with either crush (n=304) or culotte (n=56). Primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction and target vessel revascularization. The major secondary outcome measure was MACE or occurrence of CCS Class ≥2 angina. RESULTS: After a median follow-up of 4.1years (3.0-5.1), the occurrence of MACE was 23.9%. MACE or CCS Class ≥2 angina occurred in 27.5% of patients. Multivariable analysis revealed that creatinine clearance <60ml/min (odds-ratio [OR]=1.71, 95% CI 1.08-2.71; p=0.022) and left ventricular ejection fraction <40% (OR=2.14, 95% CI 1.21-3.79; p=0.008) were independent predictors of MACE or CCS Class ≥2 angina. A larger main vessel reference diameter (OR=0.57, 95% CI 0.61-0.92), bifurcation angle <50% (OR=0.59, 95% CI 0.35-0.92) and a final kissing-balloon inflation (OR=0.75, 95% CI 0.35-0.99) were associated with a lower risk of MACE or CCS Class ≥2 angina. CONCLUSIONS: Application of the crush and culotte techniques is associated with efficacy and safety at long-term follow-up. Bifurcation angle, a final kissing balloon inflation and vessel reference diameter are important variables that impact on very long-term outcomes.
Xavier Freixa; Ali A Almasood; Nadia Asif; Sanh Bui; Joan Ivanov; Mark D Osten; Douglas Ing; Christopher B Overgaard; Eric Horlick; Peter H Seidelin; Vladimír Džavík
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-8
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Peter Munk Cardiac Centre, University Health Network, Interventional Cardiology Program, Division of Cardiology, Toronto, Ontario, Canada.
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