Marco Zimarino1, Carlo Briguori2, Ignacio J Amat-Santos3, Francesco Radico4, Emanuele Barbato5, Alaide Chieffo6, Plinio Cirillo7, Ricardo A Costa8, Andrejs Erglis9, Habib Gamra10, Robert J Gil11, Vojko Kanic12, Sasko A Kedev13, Nicola Maddestra14, Sunao Nakamura15, Mariano Pellicano16, Ivo Petrov17, Maja Strozzi18, Tullio Tesorio19, Vladan Vukcevic20, Raffaele De Caterina4, Goran Stankovic20. 1. Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy; Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy. Electronic address: m.zimarino@unich.it. 2. Interventional Cardiology Unit, Clinica Mediterranea, Naples, Italy. 3. CIBERCV, Hospital Clínico Universitario de Valladolid, Spain. 4. Institute of Cardiology "G. d'Annunzio" University, Chieti, Italy. 5. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy. 6. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. 7. Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy. 8. Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil. 9. Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia. 10. Cardiology Department, Fattouma Bourguiba Hospital, University of Monastir, Tunisia. 11. Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland. 12. Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia. 13. University Clinic of Cardiology Skopje, Skopje, Macedonia. 14. Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy. 15. Department of Cardiology, New Tokyo Hospital, Chiba, Japan. 16. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy. 17. City Clinic, Sofia, Bulgaria. 18. Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia. 19. Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy. 20. Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Serbia.
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.
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.
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