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Provisional side branch-stenting for coronary bifurcation lesions: Evidence of improving procedural and clinical outcomes with contemporary techniques.
MedLine Citation:
PMID:  23441082     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: To determine whether recent technical modifications have improved clinical outcomes for patients undergoing contemporary bifurcation lesion percutaneous coronary intervention (PCI). BACKGROUND: Provisional side branch (SB)-stenting has become the preferred strategy for bifurcation PCI. Newer generation drug-eluting stents, the proximal optimization technique (POT), and the use of non-compliant (NC) balloons for final kissing inflation (FKI) have the potential to optimize outcomes. METHOD: We compared baseline characteristics, procedural and clinical outcomes in 300 consecutive patient pairs treated in 2005 and 2009. The primary outcome measure was the cumulative incidence of major adverse cardiac events (MACE) at 2-years. RESULTS: Compared to 2005, patients undergoing PCI in 2009 were at higher risk: prior MI (18%vs 8%,p=0.0004), left ventricular function (EF 54±13% vs 61±12%,p<0.0001). Cypher (53vs3%,p<0.001) and Taxus (47vs11%,p< 0.0001) stents were used more frequently in 2005, and Xience V in 2009 (0vs47%,p< 0.0001). In 2009, the POT was performed in 36% and NC balloons used for FKI in 81%. Side branch stenting was required less frequently in 2009 (9%vs 22%,p<0.001). Two-year MACE was significantly lower in 2009 than 2005 (5.7 vs 11.3%,p=0.02), a difference driven by fewer cardiac deaths (2.0vs5.0%,p=0.05). MACE was independently associated with left main bifurcation treatment (hazard ratio [HR] 1.85:95%, CI 1.04-3.29;p=0.036), side-branch stenting (HR 2.31:95% CI 1.27-4.20;p=0.006), and PCI in 2005 (HR 1.86:95% CI 1.03-3.37;p=0.004). CONCLUSIONS: Together, contemporary techniques and newer generation DES appear to improve outcomes and are both recommended for widespread uptake in patients undergoing provisional SB stenting for coronary bifurcation lesions. © 2013 Wiley Periodicals, Inc.
Authors:
Darren Mylotte; Helen Routledge; Talal Harb; Philippe Garot; Thomas Hovasse; Hakim Benamer; Thierry Unterseeh; Bernard Chevalier; Marie-Claude Morice; Yves Louvard; Thierry Lefèvre
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-25
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  -     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Wiley Periodicals, Inc., a Wiley company.
Affiliation:
Institut Cardiovasculaire Paris Sud: Institut Hospitalier Jacques Cartier Massy, Hopital Claude Galien, Quincy, France.
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