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Sheiban I, Ge Z, Kan J, Nie S, Zhang JJ, Santoso T, Munawar M, Ye F, Han Y, Chen SL. Association of peri-procedural myocardial infarction with mortality after stenting true coronary bifurcation lesions: A pooled individual participant data analysis from four randomized controlled trials. Catheter Cardiovasc Interv 2021; 99:617-626. [PMID: 34494355 DOI: 10.1002/ccd.29946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Five definitions of peri-procedural myocardial infarction (PMI) following percutaneous coronary intervention (PCI) are used in clinical trials; their clinical relevance in coronary bifurcation stenting remains unclear. OBJECTIVES To understand the correlation between PMI and mortality in bifurcation lesions from the DKCRUSH studies. METHODS PMI was defined using serum creatine kinase-myocardial band (CK-MB) values within 48 h of PCI according to the SYNTAX, Fourth Universal Definition of MI (4th UDMI), ISCHEMIA, SCAI, and EXCEL definitions. Overall, 1300 patients with both CK and CK-MB measurements pre- and post-stenting were evaluated. The association of each PMI type and all-cause death or cardiac death at a median of 5.58 years of follow-up was analyzed using Cox regression. RESULTS In total, 56 (4.3%) patients had PMI. According to SYNTAX, 4th UDMI or ISCHEMIA, SCAI, and EXCEL definitions, PMI occurred in 21 (1.6%), 56 (4.3%), 29 (2.2%), and 32 (2.5%) patients, respectively. All definitions were significantly correlated with unadjusted mortality at the end of follow-up but not at 30 days or 1-year after stenting. PMI using SYNTAX, SCAI, and EXCEL definitions rather than 4th UDMI definition was strongly associated with adjusted all-cause death. By adjusted analysis, PMI according to 4th UDMI, SCAI, and EXCEL definitions but not SYNTAX definition was positively correlated with cardiac death at a median of 5.58 years of follow-up. CK-MB ≥ 5 x UNL strongly enhanced the correlation of CK-MB values with mortality. CONCLUSIONS PMI rate varies with the definition following stenting for bifurcation lesions. PMI defined by SCAI and EXCEL definitions is strongly correlates with adjusted all-cause and cardiac death.
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Affiliation(s)
- Imad Sheiban
- Division of cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shaoping Nie
- Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Teguh Santoso
- Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
| | - Muhammad Munawar
- Binawaluya Cardiac Center and Department of Cardiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Fei Ye
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yaling Han
- Division of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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2
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Zhang S, Deng X, Yang W, Xia L, Yao K, Lu H, Ge L, Shen L, Sun A, Zou Y, Qian J, Ge J. The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction. BMC Cardiovasc Disord 2020; 20:108. [PMID: 32131738 PMCID: PMC7057519 DOI: 10.1186/s12872-020-01386-4] [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: 11/28/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The management of diagonal branch (D) occlusion is still controversary. The association between the flow loss of D and the prognosis remains unclear. We aim to detect the impact of D flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI). METHODS Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI) at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed. RESULTS A total of 392 patients (mean age of 63.9 years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n = 69) and no loss (TIMI grade2-3, n = 323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p = 0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p < 0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI. CONCLUSION Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.
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Affiliation(s)
- Shuning Zhang
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Xin Deng
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Wenlong Yang
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Liping Xia
- Department of cardiology, Shaoxing Shangyu People's Hospital, Zhejiang, China
| | - Kang Yao
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Hao Lu
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Lei Ge
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Li Shen
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Aijun Sun
- Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Yunzeng Zou
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Juying Qian
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of cardiology, Zhongshan Hospital, Fudan University, Shanghai, China. .,Shanghai Institute of Cardiovascular Diseases, Shanghai Cardiovascular Medical Center, Fudan University, Shanghai, China. .,Institutes of Biomedical Sciences, Fudan University, 1609Xietu Road, Shanghai, 200032, People's Republic of China. .,Institute of Pan-vascular Medicine, Fudan University, 1609Xietu Road, Shanghai, 200032, People's Republic of China.
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3
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Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Taniguchi Y, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes between sufficient versus insufficient diagonal branch flow in anterior acute myocardial infarction. Heart Vessels 2019; 34:1096-1103. [PMID: 30659339 DOI: 10.1007/s00380-019-01343-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/11/2019] [Indexed: 02/06/2023]
Abstract
In primary percutaneous coronary intervention (PCI), revascularization to the main branch is considered to be more important than that to the side branch. The purpose of the present study was to compare in-hospital clinical outcomes between sufficient and insufficient diagonal flow in patients with anterior ST-elevation acute myocardial infarction. A total of 229 left anterior descending artery (LAD)-AMI with final Thrombolysis in Myocardial Infarction (TIMI)-3 LAD flow were included, and divided into the sufficient diagonal flow group (TIMI-3 diagonal flow: n = 170) and the insufficient diagonal flow group (TIMI ≤ 2 diagonal flow: n = 59). The primary endpoint was the incidence of mechanical complication. The secondary endpoints were incidences of in-hospital death, heart failure at discharge, and left ventricular thrombus. There were no significant differences in the primary endpoint (the sufficient diagonal flow group: 1.2%, the insufficient diagonal flow group: 0%, P = 0.403). In-hospital death was more frequently observed in the insufficient diagonal flow group (8.5%) than the sufficient diagonal flow group (2.9%) without reaching statistical significance (P = 0.073). The incidence of heart failure at discharge, and thrombus in left ventricular were not different between the two groups. In conclusion, in-hospital outcomes were not significantly different between the sufficient and insufficient diagonal flow groups. We may not stick to the diagonal flow in LAD-STEMI, as long as the LAD flow is maintained by PCI.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan.
| | - Naoyuki Akashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Masamitsu Noguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Saitama, Japan
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4
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Li Y, Liu H, Peng W, Song Z. Nicorandil improves clinical outcomes in patients with stable angina pectoris requiring PCI: a systematic review and meta-analysis of 14 randomized trials. Expert Rev Clin Pharmacol 2018; 11:855-865. [PMID: 30079778 DOI: 10.1080/17512433.2018.1508342] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Yiliang Li
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hai Liu
- Third Department of Cardiac Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Peng
- Department of Cardiology, The Central Hospital of Loudi Affiliated to the University of South China, Loudi, China
| | - Zhi Song
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
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5
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Gwon HC. Understanding the Coronary Bifurcation Stenting. Korean Circ J 2018; 48:481-491. [PMID: 29856142 PMCID: PMC5986747 DOI: 10.4070/kcj.2018.0088] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022] Open
Abstract
Coronary bifurcation stenting is still complex and associated with a high risk of stent thrombosis and restenosis even with contemporary techniques. Although provisional approach has been proved to be the standard strategy of treatment, There is still lack of evidences for multiple steps of the procedure. For so many years we have been focused on the optimization of side branch (SB), but the clinical outcome is mostly dependent on the main vessel (MV) stenting. The optimal expansion of MV stent without the compromise of SB is the ultimate goal to achieve in the coronary bifurcation stenting. Understanding the anatomy and physiology of coronary bifurcation lesion should be the most important step to this goal. The relationship of vessel diameter between branches and the anatomical and functional significance of plaque shift and carina shift are two most important concepts to understand. They are the science behind the predictors of SB occlusion, and the rationale of proximal optimization technique and final kissing ballooning. This specific review will be devoted to review those concepts as well as clinical evidences to support them.
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Affiliation(s)
- Hyeon Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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6
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Iannaccone F, Chiastra C, Karanasos A, Migliavacca F, Gijsen F, Segers P, Mortier P, Verhegghe B, Dubini G, De Beule M, Regar E, Wentzel J. Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study. EUROINTERVENTION 2017; 13:e236-e245. [DOI: 10.4244/eij-d-16-00498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Zhang D, Xu B, Yin D, Li YP, He Y, You SJ, Qiao SB, Wu YJ, Yan HB, Yang YJ, Gao RL, Dou KF. Clinical and angiographic predictors of major side branch occlusion after main vessel stenting in coronary bifurcation lesions. Chin Med J (Engl) 2016; 128:1471-8. [PMID: 26021503 PMCID: PMC4733777 DOI: 10.4103/0366-6999.157654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Major side branch (SB) occlusion is one of the most serious complications during percutaneous coronary intervention (PCI) for bifurcation lesions. We aimed to characterize the incidence and predictors of major SB occlusion during coronary bifurcation intervention. Methods: We selected consecutive patients undergoing PCI (using one stent or provisional two stent strategy) for bifurcation lesions with major SB. All clinical characteristics, coronary angiography findings, PCI procedural factors and quantitative coronary angiographic analysis data were collected. Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting. Results: Among all 652 bifurcation lesions, 32 (4.91%) SBs occluded. No blood flow occurred in 18 lesions and TIMI flow grade decreasing occurred in 14 lesions. In multivariate analysis, diameter ratio between MV/SB (odds ratio [OR]: 7.71, 95% confidence interval [CI]: 1.53–38.85, P = 0.01), bifurcation angle (OR: 1.03, 95% CI: 1.02–1.05, P < 0.01), diameter stenosis of SB before MV stenting (OR: 1.05, 95% CI: 1.03–1.07, P < 0.01), TIMI flow grade of SB before MV stenting (OR: 3.59, 95% CI: 1.48–8.72, P < 0.01) and left ventricular eject fraction (LVEF) (OR: 1.06, 95% CI: 1.02–1.11, P < 0.01) were independent predictors of SB occlusion. Conclusions: Among clinical and angiographic findings, diameter ratio between MV/SB, bifurcation angle, diameter stenosis of SB before MV stenting, TIMI flow grade of SB before MV stenting and LVEF were predictive of major SB occlusion after MV stenting.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Ke-Fei Dou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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8
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Abstract
Side branch (SB) occlusion is one of the most serious complications of main vessel (MV) stenting. Although plaque shift has been considered the major mechanism of SB occlusion, recent studies have suggested carina shift to be the more important cause. Considering the recent pressure wire as well as intravascular ultrasonography studies, the relationship between carina shift and plaque shift in SB occlusion can be described as follows. The anatomical compromise of the SB after MV stenting is not as functionally significant as it appears, because it is mostly explained by carina shift, which is not the major cause of functional compromise. Superimposition of plaque shift over carina shift appears to be the mechanism of haemodynamically significant SB stenosis. Plaque is shifted mostly from the proximal MV, which explains why the plaque burden of the proximal MV is a significant risk factor of SB functional compromise or occlusion.
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Affiliation(s)
- Hyeon-Cheol Gwon
- Division of Cardiology, Heart Stroke Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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9
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Jang WJ, Yang JH, Choi SH, Song YB, Hahn JY, Kim WS, Lee YT, Kim BS, Gwon HC. Association of periprocedural myocardial infarction with long-term survival in patients treated with coronary revascularization therapy of chronic total occlusion. Catheter Cardiovasc Interv 2015; 87:1042-9. [DOI: 10.1002/ccd.26286] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/03/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Woo Jin Jang
- Division of Cardiology, Department of Internal Medicine; Samsung Changwon Hospital, Sungkyunkwan University School of Medicine; Changwon Republic of Korea
| | - Jeong Hoon Yang
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Seung-Hyuk Choi
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Young Bin Song
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Joo-Yong Hahn
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Wook Sung Kim
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Young Tak Lee
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
| | - Bum-Sung Kim
- Division of Cardiology, Department of Medicine; Konkuk University Medical Center; Seoul Republic of Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Republic of Korea
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10
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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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11
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Bifurcation treatment with novel, highly flexible drug-eluting coronary stents in all-comers: 2-year outcome in patients of the DUTCH PEERS trial. Clin Res Cardiol 2015; 105:206-15. [PMID: 26329584 PMCID: PMC4759225 DOI: 10.1007/s00392-015-0907-3] [Citation(s) in RCA: 7] [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: 06/30/2015] [Accepted: 08/18/2015] [Indexed: 11/04/2022]
Abstract
Background Percutaneous coronary intervention (PCI) in bifurcated lesions with second-generation drug-eluting stents (DES) was associated with increased myocardial infarction (MI) rates. Flexible stent designs that accommodate well to vessel tapering may be of benefit in challenging anatomies such as bifurcated target lesions, but so far data are scarce. Methods We analyzed the 2-year follow-up data of the DUTCH PEERS (TWENTE II) trial, which randomized 1811 all-comer patients to PCI with newer generation resolute integrity zotarolimus-eluting (Medtronic) or promus element everolimus-eluting stents (Boston Scientific). In bifurcated lesions, provisional stenting was generally performed. Target vessel failure is a composite endpoint, consisting of cardiac death, target vessel MI, or target vessel revascularization. Results Patients with at least one bifurcated lesion (n = 465, 25.7 %) versus patients with non-bifurcated target lesions only (n = 1346, 74.3 %) showed similar rates of clinical endpoints including target vessel failure (9.2 versus 7.9 %, p = 0.36) and definite stent thrombosis (0.4 versus 1.0 %, p = 0.38). Target vessel MI was more common in patients with bifurcated lesions (3.4 versus 1.6 %, p = 0.02); but after multivariate analysis with propensity score adjustment, bifurcation treatment was found not to be an independent predictor of target vessel MI (HR 1.40, 95 % CI 0.71–2.76; p = 0.34). Among patients with bifurcated lesions, DES type and side-branch size did not affect outcome, but periprocedural MI occurred more often after two-stent approaches (9.0 versus 2.1 %; p = 0.002). Conclusion All-comer patients treated for bifurcated and non-bifurcated target lesions showed similar and low rates of clinical endpoints, suggesting that the DES used are efficacious and safe for treating bifurcated target lesions.
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Chen SL, Zhang JJ, Ye F, Tian NL, Sheiban I, Jepson N, Paiboon C, Sansoto T, Kwan TW, Wen SY, Wang HC, Jiang TM, Wang Y, Chen LL, Qiu CG, Zhang YJ, Chen MX, De Maria A. Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drug-eluting stent. Catheter Cardiovasc Interv 2015; 85 Suppl 1:696-705. [PMID: 25631678 DOI: 10.1002/ccd.25857] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/07/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Shao-Liang Chen
- Cardiology, Nanjing First Hospital, Nanjing Medical University; Nanjing China
| | | | - Fei Ye
- Cardiology, Nanjing Heart Center; Nanjing China
| | - Nai-Liang Tian
- Cardiology, Nanjing First Hospital, Nanjing Medical University; Nanjing China
| | - Imad Sheiban
- Cardiology, San Giovanni Battista Hospital, University of Turin; Turin Italy
| | - Nigel Jepson
- Cardiology, Hospital of Prince Wales; Sydney Australia
| | | | - Teugh Sansoto
- Cardiology, Medistra Hospital, University of Indonesia Medical School; Indonesia
| | - Tak W. Kwan
- Cardiology, Mount Sinai Beth Israel Hospital; New York New York
| | - Shang-Yu Wen
- Cardiology, Daqing Oil General Hospital; Daqing China
| | - Hai-Chang Wang
- Cardiology, Xijing Hospital; Xi'an 4th Military Medical University; Xi'an China
| | - Tie-Ming Jiang
- Cardiology, Tianjing Policemen Medical College Hospital; Tianjing China
| | - Yan Wang
- Cardiology, Xia'Men Zhongshan Hospital; Xia'men China
| | | | - Chun-Guang Qiu
- Cardiology, Henan Provincial People's Hospital; Zhenzhou China
| | | | - Meng-Xuan Chen
- Cardiology, Emory College of Art and Science; Atlanta Georgia
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13
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Balta S, Demirkol S, Cakar M, Kurt O, Sarlak H, Celik T. The crush and culotte: two different stent techniques but same results in coronary bifurcations. Int J Cardiol 2013; 168:2894-5. [PMID: 23597576 DOI: 10.1016/j.ijcard.2013.03.092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Sevket Balta
- Gulhane Medical Academy, Department of Internal Medicine, Ankara, Turkey.
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