Document Detail


Real-world outcome of coronary bifurcation lesions in the drug-eluting stent era: results from the 4,314-patient Italian Society of Invasive Cardiology (SICI-GISE) Italian Multicenter Registry on Bifurcations (I-BIGIS).
MedLine Citation:
PMID:  20826264     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Drug-eluting stents (DESs) introduction has somewhat renewed the issues of strategy and stenting technique for treatment of bifurcation lesions. In particular, concerns remain on extensive use of DESs, especially in the side branch, and on time of dual antiplatelet therapy (DAT) discontinuation, reflecting lack of pertinent long-term data. This study aimed to evaluate clinical safety and efficacy of different strategies for bifurcations treatment in a large observational real-world registry. METHODS: A multicenter, retrospective Italian study of consecutive patients undergoing bifurcation percutaneous coronary intervention between January 2002 and December 2006 was performed. The primary end point was the long-term rate of major adverse cardiac events (MACEs). The role of DAT length on outcome was also analyzed. RESULTS: A total of 4,314 patients (4,487 lesions) were enrolled at 22 independent centers. In-hospital procedural success rate was 98.7%. After median follow-up of 24 months, MACEs occurred in 17.7%, with cardiac death in 3.4%, myocardial infarction in 4.0%, target lesion revascularization in 13.2%, and stent thrombosis in 2.9%. Extensive multivariable analysis showed that MACEs were independently predicted by age, diabetes, renal failure, systolic dysfunction, multivessel disease, myocardial infarction at admission, restenotic lesion, bare-metal stent implantation, complex stenting strategy, and short duration of DAT. CONCLUSIONS: This large study based on current clinical practice in an unselected patient population presenting with bifurcation disease and submitted to percutaneous coronary intervention demonstrated favorable long-term clinical results in this challenging patient setting, especially when DESs, simple stenting strategy, and DAT for at least 6 months are used.
Authors:
Enrico Romagnoli; Stefano De Servi; Corrado Tamburino; Antonio Colombo; Francesco Burzotta; Patrizia Presbitero; Leonardo Bolognese; Leonardo Paloscia; Paolo Rubino; Gennaro Sardella; Carlo Briguori; Federica Ettori; Gianfranco Franco; Domenico Di Girolamo; Imad Sheiban; Luigi Piatti; Cesare Greco; Sonia Petronio; Bruno Loi; Ernesto Lioy; Alberto Benassi; Aldo Patti; Achille Gaspardone; Davide Capodanno; Giuseppe G L Biondi-Zoccai; Giuseppe Sangiorgi;
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-09     Completed Date:  2010-11-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  535-542.e1     Citation Subset:  AIM; IM    
Copyright Information:
2010 Mosby, Inc. All rights reserved.
Affiliation:
San Raffaele Scientific Institute, Milan, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  instrumentation*,  methods
Coronary Artery Disease / therapy
Coronary Stenosis / therapy*
Drug-Eluting Stents*
Female
Humans
Italy
Male
Middle Aged
Registries
Research Design
Thrombosis / epidemiology
Treatment Outcome
Investigator
Investigator/Affiliation:
Romagnoli / ; Colombo / ; De Servi / ; Tamburino / ; Capodanno / ; Sangiorgi / ; Colombo / ; Burzotta / ; Presbitero / ; Bolognese / ; Paloscia / ; Rubino / ; Sardella / ; Briguori / ; Ettori / ; Franco / ; Di Girolamo / ; Sheiban / ; Biondi-Zoccai / ; Piatti / ; Cesare Greco / ; Petronio / ; Loi / ; Lioy / ; Benassi / ; Patti / ; Gaspardone / ; Sangiorgi /

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