Joo-Yong Hahn1, Woo Jung Chun2, Ji-Hwan Kim1, Young Bin Song1, Ju Hyeon Oh2, Bon-Kwon Koo3, Seung Woon Rha4, Cheol Woong Yu5, Jong-Sun Park6, Jin-Ok Jeong7, Seung-Hyuk Choi1, Jin-Ho Choi1, Myung-Ho Jeong8, Jung Han Yoon9, Yangsoo Jang10, Seung-Jea Tahk11, Hyo-Soo Kim3, Hyeon-Cheol Gwon12. 1. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea. 2. Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea. 3. Seoul National University Hospital, Seoul, Republic of Korea. 4. Korea University Guro Hospital, Seoul, Republic of Korea. 5. Sejong General Hospital, Bucheon, Republic of Korea. 6. Yeungnam University Hospital, Daegu, Republic of Korea. 7. Chungnam National University Hospital, Daejeon, Republic of Korea. 8. Chonnam National University Hospital, Gwangju, Republic of Korea. 9. Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 10. Yonsei University Severance Hospital, Seoul, Republic of Korea. 11. Ajou University Hospital, Suwon, Republic of Korea. 12. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine Seoul, Republic of Korea. Electronic address: hcgwon@skku.edu.
Abstract
OBJECTIVES: This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. BACKGROUND: SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. METHODS: Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. RESULTS: SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). CONCLUSIONS: Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes..
OBJECTIVES: This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. BACKGROUND:SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. METHODS: Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. RESULTS:SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). CONCLUSIONS: Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes..
Authors: Lei Song; Akiko Maehara; Matthew T Finn; Sanjog Kalra; Jeffrey W Moses; Manish A Parikh; Ajay J Kirtane; Michael B Collins; Tamim M Nazif; Khady N Fall; Raja Hatem; Ming Liao; Tiffany Kim; Philip Green; Ziad A Ali; Candido Batres; Martin B Leon; Gary S Mintz; Dimitri Karmpaliotis Journal: JACC Cardiovasc Interv Date: 2017-05-22 Impact factor: 11.195