Background: The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated. Methods: Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected. Results: Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%). At multivariable Cox regression, left ventricular ejection fraction ≤30% (P b 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P b 0.001), admission for an acute coronary syndrome (P b 0.001), age N66 years (P b 0.001), multivessel disease (P b 0.001) and diabetes (P b 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P b 0.001) and side branch (SB) lesion length ≥9 mm (P b 0.05) as additional independent predictors of MACE. Conclusions: Beyond traditional risk factors, multivessel disease, the length of the SB lesion, “bail-out” stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations.
Mid-term outcomes after percutaneous interventions in coronary bifurcations / Zimarino, Marco; Briguori, Carlo; Amat-Santos, Ignacio J; Radico, Francesco; Barbato, Emanuele; Chieffo, Alaide; Cirillo, Plinio; Costa, Ricardo A; Erglis, Andrejs; Gamra, Habib; Gil, Robert J; Kanic, Vojko; Kedev, Sasko A; Maddestra, Nicola; Nakamura, Sunao; Pellicano, Mariano; Petrov, Ivo; Strozzi, Maja; Tesorio, Tullio; Vukcevic, Vladan; De Caterina, Raffaele; Stankovic, Goran. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 1874-1754. - 283:(2019), pp. 78-83. [10.1016/j.ijcard.2018.11.139]
Mid-term outcomes after percutaneous interventions in coronary bifurcations
Barbato, Emanuele;Pellicano, Mariano;
2019
Abstract
Background: The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated. Methods: Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected. Results: Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%). At multivariable Cox regression, left ventricular ejection fraction ≤30% (P b 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P b 0.001), admission for an acute coronary syndrome (P b 0.001), age N66 years (P b 0.001), multivessel disease (P b 0.001) and diabetes (P b 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P b 0.001) and side branch (SB) lesion length ≥9 mm (P b 0.05) as additional independent predictors of MACE. Conclusions: Beyond traditional risk factors, multivessel disease, the length of the SB lesion, “bail-out” stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations.File | Dimensione | Formato | |
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