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Clinical outcome after percutaneous coronary intervention with drug-eluting stent in bifurcation and nonbifurcation lesions: a meta-analysis of 23 981 patients. Coron Artery Dis 2021; 31:438-445. [PMID: 32040027 DOI: 10.1097/mca.0000000000000847] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND PCI in CBL is common and technically demanding. Whether such patients have adverse outcome during the follow-up after successful PCI is unclear. We aim to compare the clinical outcome after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation of coronary bifurcation lesions (CBL) and non-CBL. METHODS We performed a systematic literature search to identify studies reporting the clinical outcome of patients undergoing PCI in CBL or not. Patients with left main disease constituted a predefined subgroup. Primary study end-point was major adverse cardiac events (MACE). RESULTS Fifteen publications on 23 891 patients with coronary artery disease treated by DES in CBL or not were identified. Median follow-up length was 24 months (range: 12-60). MACE at the longest available follow-up were significantly higher in CBL as compared with non-CBL (19.0 vs. 12.1%, P < 0.001). Similar results were obtained in the subanalysis restricted to second-generation DES studies. The MACE rate was higher early, then decreased during the follow-up being, however, appreciable at all timings up to 36 months. In the left main (LM) subanalysis (four studies, 3210 patients), patients underwent DES implantation in distal LM, as compared with nondistal LM, had increased the MACE rate during the follow-up (27.4 vs. 17.4%, P < 0.001), which was driven by higher target vessel revascularization. CONCLUSIONS In the contemporary DES era, CBL represent a subset of lesions associated with increased rate of MACE after PCI. This data prompt for studies aimed at improving the clinical outcomes of patients with CAD.
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Differential Factors for Predicting Outcomes in Left Main versus Non-Left Main Coronary Bifurcation Stenting. J Clin Med 2021; 10:jcm10143024. [PMID: 34300190 PMCID: PMC8306985 DOI: 10.3390/jcm10143024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: No large-scale study has compared the clinical and angiographic predictors of cardiovascular events in patients with left main bifurcation (LMB) and non-LMB stenting after second-generation DES implantation. Herein, we investigated differential clinical and angiographic factors for predicting outcomes in LMB versus non-LMB stenting. Methods: A total of 2648 patients with bifurcation lesions treated with second-generation DESs from the retrospective patient cohort were divided into an LMB group (n = 935) and a non-LMB group (n = 1713). The primary outcome was the 7-year incidence of target lesion failure (TLF), defined as the composite of cardiac death, myocardial infarction, and target lesion revascularization. Results: The incidence of TLF was 9.8%. Those in the LMB group were associated with a higher risk of TLF (14.2% versus 7.5%, p < 0.001) than those in the non-LMB group. Regarding the LMB group, independent predictors of TLF were chronic kidney disease (CKD), reduced left ventricular ejection fraction (LVEF), and two-stenting. Regarding the non-LMB group, CKD, reduced LVEF, old age, diabetes, and small diameter of the main vessel stent were independent predictors of TLF. Conclusions: The two-stent strategy could potentially increase TLF for the LMB lesions, and achieving the maximal diameter of the main vessel stent could result in better clinical outcomes for non-LMB lesions.
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Chen YC, Lin FY, Cheng SM, Chang CC, Chuang CL, Lin RH, Lin TY, Tsai CS. Wide-Angle Coronary Bifurcation Stenotic Lesions Treated With One Drug-Eluting Stent and Sequential Balloon Technique: A Better Strategy? Heart Lung Circ 2020; 29:437-444. [DOI: 10.1016/j.hlc.2019.02.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 01/21/2019] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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van Houwelingen KG, van der Heijden LC, Lam MK, Kok MM, Löwik MM, Louwerenburg JW, Linssen GCM, IJzerman MJ, Doggen CJM, von Birgelen C. Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial. Heart Vessels 2016; 31:1731-1739. [PMID: 26747438 PMCID: PMC5085988 DOI: 10.1007/s00380-015-0786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.
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Affiliation(s)
- K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Ming Kai Lam
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marije M Löwik
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - J W Louwerenburg
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands. .,Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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Tanaka A, Latib A, Kawamoto H, Jabbour RJ, Mangieri A, Pagnesi M, Montalto C, Regazzoli D, Ancona M, Chieffo A, Carlino M, Montorfano M, Colombo A. Clinical outcomes following bifurcation double-stenting with bioresorbable scaffolds. Catheter Cardiovasc Interv 2016; 88:854-862. [DOI: 10.1002/ccd.26579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/27/2016] [Accepted: 04/22/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Hiroyoshi Kawamoto
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Richard J. Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
- Department of Cardiology; Imperial College London; United Kingdom
| | - Antonio Mangieri
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Matteo Pagnesi
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Claudio Montalto
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Damiano Regazzoli
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Marco Ancona
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Mauro Carlino
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus; Milan Italy
- Interventional Cardiology Unit, San Raffaele Scientific Institute; Milan Italy
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Lee JM, Park KW, Koo BK, Kim HS. Stenting of coronary bifurcation lesions: a literature and technical review. Curr Cardiol Rep 2016; 17:45. [PMID: 25929543 DOI: 10.1007/s11886-015-0595-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.
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Affiliation(s)
- Joo Myung Lee
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 DaeHak-Ro, JongRo-Gu, Seoul, 110-744, South Korea
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Hermiller JB, Applegate RJ, Baird C, Butler MM, Rutledge D, Wang J, Kakarala K, Krucoff MW, Sudhir K. Clinical outcomes in real-world patients with bifurcation lesions receiving Xience V everolimus-eluting stents: Four-year results from the Xience V USA study. Catheter Cardiovasc Interv 2015; 88:62-70. [DOI: 10.1002/ccd.26217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 08/09/2015] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | | | | | - Jin Wang
- Abbott Vascular; Santa Clara California
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Lee JM, Hahn JY, Kang J, Park KW, Chun WJ, Rha SW, Yu CW, Jeong JO, Jeong MH, Yoon JH, Jang Y, Tahk SJ, Gwon HC, Koo BK, Kim HS. Differential Prognostic Effect Between First- and Second-Generation Drug-Eluting Stents in Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2015; 8:1318-1331. [DOI: 10.1016/j.jcin.2015.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 04/28/2015] [Accepted: 05/07/2015] [Indexed: 11/24/2022]
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