Sang Song P, Ryeol Ryu D, Choi SH, Yang JH, Song YB, Hahn JY, Choi JH, Seung KB, Park SJ, Gwon HC. Impact of acute coronary syndrome classification and procedural technique on clinical outcomes in patients with coronary bifurcation lesions treated with drug-eluting stents.
Clin Cardiol 2012;
35:610-8. [PMID:
22707283 DOI:
10.1002/clc.22020]
[Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 04/27/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND
We examined the impact of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) on clinical outcomes in patients with bifurcation lesions treated with drug-eluting stents.
HYPOTHESIS
We hypothesized that NSTE-ACS would be attributable to the increased risk of major adverse cardiac events (MACE) in bifurcation percutaneous coronary intervention.
METHODS
We enrolled 1668 patients, using data from a multicenter real-world bifurcation registry. The primary objective was to compare the 2-year cumulative risk of MACE in patients with NSTE-ACS to those with stable angina. Major adverse cardiac events were defined as the composite endpoint of cardiac death, myocardial infarction (MI), and target-lesion revascularization.
RESULTS
Non-ST-segment elevation acute coronary syndrome was seen in 969 (58.1%) patients and stable angina in 699. Major adverse cardiac events occurred in 7.3% of NSTE-ACS patients and in 5.2% with stable angina (P = 0.042). However, cardiac death, MI, and target-lesion revascularization were similar between the 2 groups. We stratified patients with NSTE-ACS into those with non-ST-segment elevation MI and those with unstable angina. Cumulative risks of 2-year MACEs were 7.0% in non-ST-segment elevation MI patients and 7.5% in unstable angina patients (P = 0.87). In the NSTE-ACS cohort, the baseline lesion length in the side branch (adjusted hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01-1.07, P = 0.022), paclitaxel-eluting stents in the main vessel (adjusted HR: 2.02, 95% CI: 1.21-3.40, P = 0.008), and final kissing ballooning (adjusted HR: 1.88, 95% CI: 1.10-3.21, P = 0.021) were independent predictors of MACE.
CONCLUSIONS
Compared with stable angina patients, the NSTE-ACS patients who underwent bifurcation percutaneous coronary intervention had an increased risk of MACE during the 2-year follow-up.
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