An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study
Abstract
:1. Introduction
2. Methods
2.1. Patient Population
2.2. Procedures
2.3. Bifurcation Stenting Techniques
2.4. Quantitative Coronary Angiography
2.5. Clinical Follow-Up
2.6. Statistical Analysis
3. Results
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variables | |
---|---|
Age (years), mean ± SD | 62 ± 10 |
Sex (female) n, (%) | 76 (37.8) |
Hypertension n, (%) | 111 (55.2) |
Diabetes mellitus n, (%) | 50 (24.9) |
Hypercholesterolemia n, (%) | 90 (44.8) |
Family history n, (%) | 59 (29.4) |
Smoking status n, (%) | 47 (23.4) |
Ejection fraction, (%) | 51 ± 8 |
Prior percutaneous coronary intervention n, (%) | 25 (12.4) |
Prior coronary surgery n, (%) | 9 (4.5) |
Chronic kidney disease n, (%) | 11 (5.5) |
Clinical presentation n, (%) | |
Unstable angina pectoris n, (%) | 63 (31.3) |
Non-ST-elevation myocardial infarction n, (%) | 93 (46.3) |
ST-elevation myocardial infarction n, (%) | 45 (22.4) |
Variables | |
---|---|
Lesion location, n (%) | |
LAD-Diagonal | 119 (59.2) |
LCx-OM | 39 (19.4) |
RPDA-RPLA | 43 (21.4) |
Medina classification, n (%) | |
1,1,1 | 143 (71.1) |
1,0,1 | 26 (12.9) |
0,1,1 | 32 (15.9) |
Bifurcation angle, n (%) | |
<70° | 179 (89) |
≥70° | 22 (11) |
Pre-PCI coronary TIMI-3 flow, n (%) | |
Main branch | 159 (79) |
Side branch | 173 (86) |
Two-stent techniques, n (%) | |
Mini-crush | 125 (62.2) |
Culotte | 44 (21.9) |
V-stenting | 32 (15.9) |
Transradial approach, n (%) | 75 (37.3) |
Glycoprotein 2b/3a inhibitors, n (%) | 23 (11.4) |
The number of stents used per patient | 2.25 ± 0.5 |
Lesion and stent lenghts, (mm) | |
Main branch lesion lenght | 22.6 ± 5.7 |
Main branch stent lenght | 26.4 ± 6.5 |
Side branch lesion lenght | 11.2 ± 4.0 |
Side branch stent lenght | 15.0 ± 4.3 |
Stent types, n (%) | |
Everolimus eluting stent | 143 (71.1) |
Zotarolimus eluting stent | 34 (16.9) |
Sirolimus eluting stent | 24 (11.9) |
Antiplatelet therapy, n (%) | |
Clopidogrel | 48 (23.9) |
Ticagrelor | 153 (76.1) |
Intravascular ultrasonography use, n (%) | 83 (41) |
Procedural features, n (%) | |
Predilation in main branch | 135 (67) |
Predilation in side branch | 69 (34) |
Angiographic success | 189 (94) |
Procedural success | 188 (93.5) |
Unsatisfactory final kissing balloon inflation | 10 (5) |
Procedure time (min), mean ± SD | 73 ± 22 |
Follow-up (years), median (IQR) | 2.1 (1.7–2.5) |
Variables | n (%) |
---|---|
(A) MACE rates in hospital | 3 (1.5) |
(1) Non-fatal myocardial infarction | 0 (0.0) |
(2) Cardiac death | 3 (1.5) |
(3) Target lesion revascularization | 0 (0.0) |
(B) Cumulative MACE rates at 2 years | 34 (16.9) |
(1) Non-fatal myocardial infarction | 3 (1.5) |
(2) Cardiac death | 7 (3.5) |
(3) Target lesion revascularization | 27 (13.4) |
(3a) Percutaneous coronary intervention | 16 (8.0) |
(3b) Coronary artery bypass grafting | 11 (5.5) |
Pre-Procedure | Post-Procedure | p-Value | |
---|---|---|---|
Proximal main branch | |||
Reference vessel diameter (mm) | 3.10 ± 0.38 | 3.11 ± 0.38 | 0.071 |
Minimum lumen diameter (mm) | 0.67 ± 0.32 | 2.97 ± 0.36 | <0.001 |
Diameter stenosis, % | 78 ± 9.7 | 4.4 ± 3.3 | <0.001 |
Distal main branch | |||
Reference vessel diameter (mm) | 2.91 ± 0.34 | 2.92 ± 0.33 | 0.160 |
Minimum lumen diameter (mm) | 0.61 ± 0.23 | 2.77 ± 0.36 | <0.001 |
Diameter stenosis, % | 79 ± 7.2 | 5.5 ± 2.3 | <0.001 |
Side branch | |||
Reference vessel diameter (mm) | 2.7 ± 0.22 | 2.7 ± 0.22 | 0.575 |
Minimum lumen diameter (mm) | 0.69 ± 0.24 | 2.53 ± 0.26 | <0.001 |
Diameter stenosis, % | 74 ± 8.6 | 5.7 ± 5.6 | <0.001 |
Variables | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
OR | 95% CI | p-Value | OR | 95% CI | p-Value | |
Clinical parameters | ||||||
Age (mean, years) | 1.06 | 1.02–1.09 | 0.004 | 1.04 | 0.99-1.10 | 0.095 |
Sex (female) | 1.57 | 0.70–3.49 | 0.270 | |||
Hypertension | 1.38 | 0.65–2.94 | 0.401 | |||
Diabetes mellitus | 2.18 | 0.99–4.75 | 0.048 | 2.35 | 0.75-7.30 | 0.139 |
1.85 * | −0.057–2.03 | 0.166 | ||||
Hypercholesterolemia | 1.11 | 0.52–2.34 | 0.769 | |||
Ejection fraction | 0.94 | 0.89–0.99 | 0.019 | 0.96 | 0.91–1.02 | 0.228 |
Chronic kidney disease | 0.98 | 0.91–3.67 | 0.881 | |||
Unstable angina | 1.24 | 0.57–2.69 | 0.586 | |||
NSTEMI | 0.90 | 0.43–1.89 | 0.783 | |||
STEMI | 0.88 | 0.35–2.18 | 0.782 | |||
Clopidogrel (vs ticagrelor) | 11.8 | 5.15–27.36 | <0.001 | 5.48 | 1.68–17.94 | 0.005 |
2.19 * | 0.41–2.51 | 0.007 | ||||
Anatomic, angiographic and procedural parameters | ||||||
LAD-Diagonal | 0.55 | 0.26–1.16 | 0.117 | |||
LCx-OM | 1.98 | 0.85–4.59 | 0.110 | |||
RPDA-RPLA | 1.16 | 0.48–2.78 | 0.739 | |||
Medina (1,1,1) | 2.69 | 0.98–7.35 | 0.046 | 2.72 | 0.72–10.26 | 0.140 |
1.41 * | −0.33–2.11 | 0.158 | ||||
Medina (1,0,1) | 0.60 | 0.17–2.14 | 0.437 | |||
Medina (0,1,1) | 0.28 | 0.06–1.25 | 0.097 | |||
Mini-Crush | 1.56 | 0.70–3.49 | 0.270 | |||
Culotte | 0.91 | 0.36–2.25 | 0.840 | |||
V-stenting | 0.46 | 0.13–1.61 | 0.224 | |||
The number of stents | 3.02 | 1.61–5.66 | 0.001 | 1.72 | 0.57–5.20 | 0.333 |
ZES (vs everolimus) | 1.34 | 0.53–3.40 | 0.532 | |||
SES (vs everolimus) | 17.67 | 6.64–47.01 | <0.001 | 5.02 | 1.34–18.81 | 0.017 |
1.86 * | 0.31–2.64 | 0.014 | ||||
MB stent length | 1.10 | 1.04–1.17 | 0.001 | 1.19 | 0.71–2.01 | 0.499 |
MB proximal-MLD (bp) | 2.23 | 0.72–6.92 | 0.163 | |||
MB distal-MLD (bp) | 1.32 | 0.27–6.29 | 0.728 | |||
MB proximal-MLD (ap) | 1.61 | 0.61–4.24 | 0.333 | |||
MB distal-MLD (ap) | 1.40 | 0.54–5.31 | 0.107 | |||
Side branch lesion length | 1.07 | 0.97–1.17 | 0.164 | |||
Side branch stent length | 1.06 | 0.98–1.16 | 0.148 | |||
Side branch MLD (bp) | 2.00 | 0.46–8.70 | 0.356 | |||
Side branch MLD (ap) | 3.06 | 0.81–11.63 | 0.100 | |||
Procedure time | 1.02 | 1.00–1.04 | 0.019 | 1.02 | 0.99–1.04 | 0.175 |
Unsatisfactory final kissing | 5.59 | 1.52–20.52 | 0.010 | 4.77 | 0.86–26.45 | 0.074 |
1.71 * | −0.21–3.02 | 0.087 |
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Yurtdaş, M.; Asoğlu, R.; Özdemir, M.; Asoğlu, E. An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study. Medicina 2020, 56, 102. https://doi.org/10.3390/medicina56030102
Yurtdaş M, Asoğlu R, Özdemir M, Asoğlu E. An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study. Medicina. 2020; 56(3):102. https://doi.org/10.3390/medicina56030102
Chicago/Turabian StyleYurtdaş, Mustafa, Ramazan Asoğlu, Mahmut Özdemir, and Emin Asoğlu. 2020. "An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study" Medicina 56, no. 3: 102. https://doi.org/10.3390/medicina56030102
APA StyleYurtdaş, M., Asoğlu, R., Özdemir, M., & Asoğlu, E. (2020). An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study. Medicina, 56(3), 102. https://doi.org/10.3390/medicina56030102