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Mid-term outcomes after percutaneous interventions in coronary bifurcations.

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 < 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P < 0.001), admission for an acute coronary syndrome (P < 0.001), age >66 years (P < 0.001), multivessel disease (P < 0.001) and diabetes (P < 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P < 0.001) and side branch (SB) lesion length ≥9 mm (P < 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. This highlights the importance of a carefully planned PCI strategy and adequate therapy adherence to improve the clinical outcomes in these patients. CLINICAL TRIAL REGISTRATION:URL: https://www.clinicaltrials.gov. Unique identifier: NCT01967615.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Zimarino M,Briguori C,Amat-Santos IJ,Radico F,Barbato E,Chieffo A,Cirillo P,Costa RA,Erglis A,Gamra H,Gil RJ,Kanic V,Kedev SA,Maddestra N,Nakamura S,Pellicano M,Petrov I,Strozzi M,Tesorio T,Vukcevic V,De Caterina

doi

10.1016/j.ijcard.2018.11.139

subject

Has Abstract

pub_date

2019-05-15 00:00:00

pages

78-83

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(18)34855-1

journal_volume

283

pub_type

杂志文章,多中心研究

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Mid-term outcomes after percutaneous interventions in coronary bifurcations.