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Provisional side branch‐stenting for coronary bifurcation lesions
Author(s) -
Mylotte Darren,
Routledge Helen,
Harb Talal,
Garot Philippe,
Hovasse Thomas,
Benamer Hakim,
Unterseeh Thierry,
Chevalier Bernard,
Morice MarieClaude,
Louvard Yves,
Lefèvre Thierry
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24901
Subject(s) - medicine , mace , conventional pci , percutaneous coronary intervention , myocardial infarction , cardiology , hazard ratio , cumulative incidence , stent , confidence interval , cohort
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 (DESs), the proximal optimization technique (POT), and the use of noncompliant (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 myocardial infarction (18% vs. 8%, P = 0.0004), left ventricular function (EF 54 ± 13% vs. 61 ± 12%, P < 0.0001). Cypher (53 vs. 3%, P < 0.001) and Taxus (47 vs. 11%, P < 0.0001) stents were used more frequently in 2005, and Xience V in 2009 (0 vs. 47%, P < 0.0001). In 2009, the POT was performed in 36% and NC balloons used for FKI in 81%. SB 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 (2.0 vs. 5.0%, 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.