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Suryawan IGR, Saputra PBT, Rurus MESE, Saputra ME, Widiarti W, Multazam CECZ, Alkaff FF. Comparison between provisional and dual systematic stenting approach for left main bifurcation disease: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102633. [PMID: 38744356 DOI: 10.1016/j.cpcardiol.2024.102633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Despite recent advancements, challenges persist in determining the optimal stenting strategy for LM bifurcation disease. Hence, this systematic review aims to compare single provisional and systematic dual stenting for managing LM bifurcation disease. A systematic search was performed until January 14, 2024. For the effect measure, risk ratios (RRs) was calculated. This study included 22 studies with 10776 participants. The all-cause mortality and cardiovascular mortality revealed comparable outcomes between provisional and dual-systematic stenting (RR 1.13, CI95 %: 0.87-1.47, p 0.36, I2 59 %; RR 1.16, CI95 %: 0.73-1.84, p 0.63, I2 80 %). In addition, MACE, MI, TLR, TVR, and in stent thrombosis also showed similar findings. Subgroup analysis revealed that cohort studies was the source of heterogeneity in all-cause mortality, stent thrombosis, and TLR. This meta-analysis suggests comparable outcomes between provisional and dual-systematic stenting in managing LM bifurcation disease. Further study is needed to validate the outcomes of novel techniques.
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Affiliation(s)
- I Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia.
| | - Pandit Bagus Tri Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Made Edgard Surya Erlangga Rurus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Mahendra Eko Saputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia; Cardiovascular Research and Innovation Center, Universitas Airlangga, Surabaya, Indonesia
| | - Wynne Widiarti
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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2
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Shin D, Shlofmitz E. Editorial: Between too much and too little metal in the left main bifurcation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 61:6-7. [PMID: 38233250 DOI: 10.1016/j.carrev.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Doosup Shin
- Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, USA
| | - Evan Shlofmitz
- Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, NY, USA.
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Lee JH, Youn YJ, Jeon HS, Lee JW, Ahn SG, Yoon J, Gwon HC, Song YB, Choi KH, Kim HS, Chun WJ, Hur SH, Nam CW, Cho YK, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Lee HJ. Transradial Versus Transfemoral Access for Bifurcation Percutaneous Coronary Intervention Using Second-Generation Drug-Eluting Stent. J Korean Med Sci 2024; 39:e111. [PMID: 38501187 PMCID: PMC10948262 DOI: 10.3346/jkms.2024.39.e111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/23/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The benefits of transradial access (TRA) over transfemoral access (TFA) for bifurcation percutaneous coronary intervention (PCI) are uncertain because of the limited availability of device selection. This study aimed to compare the procedural differences and the in-hospital and long-term outcomes of TRA and TFA for bifurcation PCI using second-generation drug-eluting stents (DESs). METHODS Based on data from the Coronary Bifurcation Stenting Registry III, a retrospective registry of 2,648 patients undergoing bifurcation PCI with second-generation DES from 21 centers in South Korea, patients were categorized into the TRA group (n = 1,507) or the TFA group (n = 1,141). After propensity score matching (PSM), procedural differences, in-hospital outcomes, and device-oriented composite outcomes (DOCOs; a composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) were compared between the two groups (772 matched patients each group). RESULTS Despite well-balanced baseline clinical and lesion characteristics after PSM, the use of the two-stent strategy (14.2% vs. 23.7%, P = 0.001) and the incidence of in-hospital adverse outcomes, primarily driven by access site complications (2.2% vs. 4.4%, P = 0.015), were significantly lower in the TRA group than in the TFA group. At the 5-year follow-up, the incidence of DOCOs was similar between the groups (6.3% vs. 7.1%, P = 0.639). CONCLUSION The findings suggested that TRA may be safer than TFA for bifurcation PCI using second-generation DESs. Despite differences in treatment strategy, TRA was associated with similar long-term clinical outcomes as those of TFA. Therefore, TRA might be the preferred access for bifurcation PCI using second-generation DES. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03068494.
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Affiliation(s)
- Jung-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Young Jin Youn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Ho Sung Jeon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jun-Won Lee
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Centre, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Centre, Keimyung University College of Medicine, Daegu, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Centre, Keimyung University College of Medicine, Daegu, Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Centre, Keimyung University College of Medicine, Daegu, Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Do-Sun Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - So-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Ajou University College of Medicine, Suwon, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
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Kim JH, Kang DY, Ahn JM, Kweon J, Choi Y, Kim H, Lee J, Chae J, Kang SJ, Park DW, Park SJ. Optimal Minimal Stent Area and Impact of Stent Underexpansion in Left Main Up-Front 2-Stent Strategy. Circ Cardiovasc Interv 2024; 17:e013006. [PMID: 38227699 DOI: 10.1161/circinterventions.123.013006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 09/26/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND We previously reported the use of minimal stent area to predict angiographic in-stent restenosis after drug-eluting stent implantation for unprotected left main (LM) disease. We aimed to evaluate the optimal minimal stent area criteria for up-front LM 2-stenting based on long-term clinical outcomes. METHODS We identified 292 consecutive patients with LM bifurcation stenosis who were treated using the crush technique. The final minimal stent area was measured in the ostial left anterior descending artery (LAD), ostial left circumflex artery (LCX), and distal LM. The primary outcome was 5-year major adverse cardiac events, including all-cause death, myocardial infarction, and target lesion revascularization. RESULTS The minimal stent area cutoff values that best predicted the 5-year major adverse cardiac events were 11.8 mm2 for distal LM (area under the curve, 0.57; P=0.15), 8.3 mm2 for LAD ostium (area under the curve, 0.62; P=0.02), and 5.7 mm2 for LCX ostium (area under the curve, 0.64; P=0.01). Using these criteria, the risk of 5-year major adverse cardiac events was significantly associated with stent underexpansion in the LAD ostium (hazard ratio, 3.14; [95% CI, 1.23-8.06]; P=0.02) and LCX ostium (hazard ratio, 2.60 [95% CI, 1.11-6.07]; P=0.03) but not in the distal LM (hazard ratio, 0.81 [95% CI, 0.34-1.91]; P=0.63). Patients with stent underexpansion in both ostial LAD and LCX had a significantly higher rate of 5-year major adverse cardiac events than those with no or 1 underexpanded stent of either ostium (P<0.01). CONCLUSIONS Stent underexpansion in the LAD and LCX ostium was significantly associated with long-term outcomes in patients who underwent up-front 2-stenting for LM bifurcation stenosis.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea (J.H.K.)
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jihoon Kweon
- Department of Convergence Medicine, Asan Medical Center, Seoul, Republic of Korea (J.K., J.C.)
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Jihye Chae
- Department of Convergence Medicine, Asan Medical Center, Seoul, Republic of Korea (J.K., J.C.)
| | - Soo-Jin Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.-Y.K., J.-M.A., Y.C., H.K., J.L., S.-J.K., D.-W.P., S.-J.P.)
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5
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Choi KH, Bruno F, Cho YK, De Luca L, Song YB, Kang J, Mattesini A, Gwon HC, Truffa A, Kim HS, Wańha W, Chun WJ, Gili S, Hur SH, Helft G, Han SH, Cortese B, Lee CH, Escaned J, Yoon HJ, Chieffo A, Hahn JY, Gallone G, Choi SH, De Ferrari G, Koo BK, Quadri G, D'Ascenzo F, Nam CW, de Filippo O. Comparison of Outcomes Between 1- and 2-Stent Techniques for Medina Classification 0.0.1 Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2023; 16:2083-2093. [PMID: 37565964 DOI: 10.1016/j.jcin.2023.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Although Medina 0.0.1 bifurcation lesions are often treated by percutaneous coronary intervention (PCI) in real-world practice, the optimal revascularization strategy for this lesion is uncertain. OBJECTIVES The current study aimed to compare the clinical outcomes between 1- and 2-stent strategies in patients treated with PCI for Medina 0.0.1 bifurcation lesions. METHODS The extended BIFURCAT (Combined Insights From the Unified RAIN [Very Thin Stents for Patients with Left Main or Bifurcation in Real Life] and COBIS [Coronary Bifurcation Stenting] Bifurcation Registries) registry was obtained by patient-level merging the dedicated bifurcation COBIS II, III, and RAIN registries. Among 8,434 patients with bifurcation lesions undergoing PCI, 345 (4.1%) with Medina 0.0.1 lesions were selected for the current analysis. The primary endpoint was major adverse cardiac event (MACE, a composite of all-cause death, myocardial infarction, target vessel revascularization, and stent thrombosis) at 800 days. RESULTS In the total population, 209 patients (60.6%) received PCI with a 1-stent strategy and the remaining 136 patients (39.4%) with a 2-stent strategy. There was a tendency for higher use of a 1-stent strategy over time (36.0%, 47.4%, and 90.4% in 2003-2009, 2010-2014, and 2015-2017, respectively; P for trend < 0.001). For the treatment of Medina 0.0.1 lesions, there was no significant difference in the risk of MACE between 1- and 2-stent strategies (1 stent vs 2 stent, 14.3% vs 13.9%; HR: 1.034; 95% CI: 0.541-1.977; P = 0.92). The risk of MACE was also not significantly different when stratifying into 3 groups (1-stent crossover only, 1-stent with strut opening, and 2-stent strategy). CONCLUSIONS In patients with a Medina 0.0.1 type bifurcation lesion, PCI with a 1-stent strategy showed comparable outcomes to that of a 2-stent strategy. (Coronary Bifurcation Stenting II [COBIS II]; NCT01642992; Coronary Bifurcation Stenting III [COBIS III]; NCT03068494; Very Thin Stents for Patients with Left Main or Bifurcation in Real Life [RAIN]; NCT03544294).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Francesco Bruno
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Alessio Mattesini
- Cardiologia Interventistica Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wojciech Wańha
- Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | | | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Gerard Helft
- Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | | | - Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | | | - Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Alaide Chieffo
- Division of Cardiology, Ospedale San Raffaele, Milan, Italy
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Guglielmo Gallone
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gaetano De Ferrari
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Giorgio Quadri
- Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy
| | - Fabrizio D'Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea.
| | - Ovidio de Filippo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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Fujimura T, Okamura T, Nagoshi R, Murasato Y, Yamawaki M, Miyazaki Y, Akase H, Ono S, Serikawa T, Hikichi Y, Norita H, Nakao F, Sakamoto T, Shinke T, Shite J. Serial changes of the side-branch ostial area after single crossover stenting with kissing-balloon inflation. Int J Cardiovasc Imaging 2023; 39:1593-1603. [PMID: 37191834 PMCID: PMC10504099 DOI: 10.1007/s10554-023-02853-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE We aimed to investigate the serial change of the side-branch ostial area (SBOA) depended on the wire-position before Kissing-balloon inflation (KBI) in the single-stent strategy for bifurcation lesions separately in the left main coronary artery (LMCA) and in non-LMCA. METHODS Patients who underwent a single-stent KBI for a bifurcation lesion and had OCT images at the timing of the rewiring, at the post-procedure, and at the 9-month follow-up were extracted from the 3D-OCT Bifurcation Registry, which is a multicenter-prospective registry of patients with a percutaneous coronary intervention for a bifurcation lesion under OCT guidance. The SBOA was measured by dedicated software, and the rewiring position at the side-branch ostium after crossover stenting was assessed by three-dimensional-optical coherence tomography (3D-OCT). The optimal rewiring was defined as link-free-type and distal rewiring. The relationship between the optimal rewiring and the serial change of the SBOA was investigated separately in LMCA and non-LMCA cases. RESULTS We examined 75 bifurcation lesions (LMCA, n = 35; non-LMCA, n = 40). The serial changes of the SBOA with the optimal rewiring were not significantly different regardless of LMCA and non-LMCA (LMCA:3.96 to 3.73 mm2, p = 0.38; non-LMCA:2.16 to 2.21 mm2, p = 0.98), whereas the serial changes of the SBOA with the sub-optimal rewiring were significantly reduced (LMCA:6.75 to 5.54 mm2, p = 0.013; non-LMCA:2.28 mm2 to 2.09 mm2, p = 0.024). There was no significant difference in clinical events between the optimal and sub-optimal rewiring group regardless of the LMCA and non-LMCA. CONCLUSION The side-branch ostial area dilated with the optimal rewiring position in a bifurcation lesion treated with single crossover stenting and kissing-balloon inflation was preserved regardless of whether the bifurcation was in the LMCA or a non-LMCA.
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Affiliation(s)
- Tatsuhiro Fujimura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, Ube, 755-8505, Japan
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, Ube, 755-8505, Japan.
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyusyu Medical Center, Fukuoka, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, Ube, 755-8505, Japan
| | - Hideaki Akase
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, Ube, 755-8505, Japan
| | - Shiro Ono
- Department of Cardiology, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan
| | - Takeshi Serikawa
- Department of Cardiology, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Yutaka Hikichi
- Department of Cardiology, Saga-Ken Medical Center Koseikan, Saga, Japan
| | | | - Fumiaki Nakao
- Department of Cardiology, Yamaguchi Grand Medical Center, Hofu, Japan
| | - Tomohiro Sakamoto
- Department of Cardiology, Saiseikai Kumamoto General Hospital, Kumamoto, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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7
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Meng S, Kong X, Nan J, Yang X, Li J, Yang S, Zhao L, Jin Z. Comparing the clinical outcomes of single vs. systematic dual stenting strategies for unprotected left main bifurcation lesion: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1145412. [PMID: 37554363 PMCID: PMC10405628 DOI: 10.3389/fcvm.2023.1145412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/12/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION The optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. This meta-analysis compared the medium and long-term follow-up clinical outcomes of single vs. systematic dual stenting strategies of LM bifurcation lesions. METHODS We systematically identified studies published within 5 years comparing single vs. systematic double stenting strategies for LM bifurcation lesions. The primary endpoint was medium-term (1 year) and long-term (at least 3 years) all-cause death. Secondary outcomes included major adverse cardiovascular events (MACEs), target lesion revascularization (TLR), overall occurrence of stent thrombosis (ST), cardiovascular (CV) mortality, and myocardial infarction (MI). RESULTS Two randomized controlled trials and nine observational studies with 7,318 patients were included in this meta-analysis. In terms of the medium-term follow-up clinical outcomes, our pooled analysis showed that use of the systematic dual stenting strategy was associated with a lower ST risk (odds ratio [OR] = 0.43, 95% confidence interval [CI]: 0.20-0.89, P = 0.02) and cardiac death risk (OR = 0.43, 95% CI: 0.21-0.89, P = 0.02) compared to the single stenting strategy; there was no significant difference between the two strategies regarding rates of all-cause death, MACE, TLR, and MI. Patients with long-term follow-up showed comparable observed clinical outcomes between the two strategies. Most importantly, for patients with true LM bifurcation, the risk of all-cause death, ST, and CV mortality following the systematic dual stenting strategy was significantly lower than the single stenting strategy. CONCLUSIONS For patients with LM bifurcation lesions, both the systematic dual stenting strategy and single stenting strategy demonstrated comparable results in terms of all-cause mortality during medium-term and long-term follow-up. However, the systematic dual stenting strategy showed a tendency towards lower incidence of ST and CV mortality compared to the single stenting strategy during medium-term follow-up. Consequently, the systematic dual stenting strategy yielded superior clinical outcomes for patients with LM bifurcation lesions.
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Affiliation(s)
- Shuai Meng
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangyun Kong
- Department of General Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jing Nan
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingsheng Yang
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianan Li
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shenghua Yang
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lihan Zhao
- Department of General Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Zening Jin
- Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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8
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Rola P, Kulczycki JJ, Barycki M, Włodarczak S, Furtan Ł, Kędzierska M, Giniewicz K, Doroszko A, Lesiak M, Włodarczak A. Comparison of Orbital Atherectomy and Rotational Atherectomy in Calcified Left Main Disease: Short-Term Outcomes. J Clin Med 2023; 12:4025. [PMID: 37373718 DOI: 10.3390/jcm12124025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Coronary calcifications, particularly in left main disease (LMD), are independently associated with adverse outcomes of percutaneous coronary intervention (PCI). Adequate lesion preparation is pivotal to achieve favorable short- and long-term outcomes. Rotational atherectomy devices have been used in contemporary practice to obtain adequate preparation of the calcified lesions. Recently, novel orbital atherectomy (OA) devices have been introduced to clinical practice to facilitate the preparation of the lesion. The objective of this study is to compare the short-term safety and efficacy of orbital and rotational atherectomy for LMD. METHODS we retrospectively evaluated a total of 55 consecutive patients who underwent the LM PCI supported by either OA or RA. RESULTS The OA group consisted of 25 patients with a median SYNTAX Score of 28 (26-36). The Rota group consisted of 30 patients with a median SYNTAX Score of 28 (26-33.1) There were no statistical differences in MACCE between the RA and OA subpopulations when recorded in-hospital (6.7% vs. 10.3% p = 0.619) as well as in a 1-month follow-up after the procedure (12% vs. 16.6% p = 0.261). CONCLUSION OA and RA seem to be similarly safe and effective strategies for preparating the lesion in the high-risk population with calcified LMD.
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Affiliation(s)
- Piotr Rola
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | - Jan Jakub Kulczycki
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
| | - Mateusz Barycki
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | - Szymon Włodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
| | - Łukasz Furtan
- Department of Cardiology, Provincial Specialized Hospital, 59-220 Legnica, Poland
| | | | | | - Adrian Doroszko
- Clinical Department of Internal Medicine and Occupational Diseases, Hypertension and Clinical Oncology, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, 61-848 Poznan, Poland
| | - Adrian Włodarczak
- Faculty of Health Sciences and Physical Culture, Witelon Collegium State University, 59-220 Legnica, Poland
- Department of Cardiology, The Copper Health Centre (MCZ), 59-300 Lubin, Poland
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Kim JH, Franchin L, Hong SJ, Cha JJ, Lim S, Joo HJ, Park JH, Yu CW, Lim DS, Filippo OD, Gwon HC, Piroli F, Kim HS, Wanha W, Choi KH, Song YB, Patti G, Nam CW, Bruno F, Kang J, Bocchino PP, De Ferrari GM, Koo BK, D’Ascenzo F. Two-Year clinical outcomes after coronary bifurcation stenting in older patients from Korea and Italy. Front Cardiovasc Med 2023; 10:1106594. [PMID: 37034327 PMCID: PMC10076885 DOI: 10.3389/fcvm.2023.1106594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background Older patients who treated by percutaneous coronary intervention (PCI) are at a higher risk of adverse cardiac outcomes. We sought to investigate the clinical impact of bifurcation PCI in older patients from Korea and Italy. Methods We selected 5,537 patients who underwent bifurcation PCI from the BIFURCAT (comBined Insights from the Unified RAIN and COBIS bifurcAtion regisTries) database. The primary outcome was a composite of target vessel myocardial infarction, clinically driven target lesion revascularization, and stent thrombosis at two years. Results In patients aged ≥75 years, the mean age was 80.1 ± 4.0 years, 65.2% were men, and 33.7% had diabetes. Older patients more frequently presented with chronic kidney disease (CKD), severe coronary calcification, and left main coronary artery disease (LMCA). During a median follow-up of 2.1 years, older patients showed similar adverse clinical outcomes compared to younger patients (the primary outcome, 5.7% vs. 4.5%; p = 0.21). Advanced age was not an independent predictor of the primary outcome (p = 0.93) in overall patients. Both CKD and LMCA were independent predictors regardless of age group. Conclusions Older patients (≥75 years) showed similar clinical outcomes to those of younger patients after bifurcation PCI. Advanced age alone should not deter physicians from performing complex PCIs for bifurcation disease.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Luca Franchin
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Correspondence: Soon Jun Hong
| | - Jung-Joon Cha
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Subin Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Do-Sun Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Francesco Piroli
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wojciech Wanha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Giuseppe Patti
- Department of Thoracic and Cardiovascular Diseases, Maggiore Della Carita Hospital, Novara, Italy
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pier Paolo Bocchino
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, University of Turin, Turin, Italy
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10
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Cha JJ, Hong SJ, Kim JH, Lim S, Joo HJ, Park JH, Yu CW, Kang J, Kim HS, Gwon HC, Chun WJ, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Song YB, Choi KH, Nam CW, Koo BK, Lim DS. Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients. Front Cardiovasc Med 2022; 9:1018802. [PMID: 36620646 PMCID: PMC9811589 DOI: 10.3389/fcvm.2022.1018802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes mellitus (DM) is a critical risk factor for the pathogenesis and progression of coronary artery disease, with a higher prevalence of complex coronary artery disease, including bifurcation lesions. This study aimed to elucidate the optimal stenting strategy for coronary bifurcation lesions in patients with DM. Methods A total of 905 patients with DM and bifurcation lesions treated with second-generation drug-eluting stents (DES) from a multicenter retrospective patient cohort were analyzed. The primary outcome was the 5-year incidence of target lesion failure (TLF), which was defined as a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization. Results Among all patients with DM with significant bifurcation lesions, 729 (80.6%) and 176 (19.4%) were treated with one- and two-stent strategies, respectively. TLF incidence differed according to the stenting strategy during the mean follow-up of 42 ± 20 months. Among the stent strategies, T- and V-stents were associated with a higher TLF incidence than one-stent strategy (24.0 vs. 7.3%, p < 0.001), whereas no difference was observed in TLF between the one-stent strategy and crush or culotte technique (7.3 vs. 5.9%, p = 0.645). The T- or V-stent technique was an independent predictor of TLF in multivariate analysis (hazard ratio, 3.592; 95% confidence interval, 2.117-6.095; p < 0.001). Chronic kidney disease, reduced left ventricular ejection fraction, and left main bifurcation were independent predictors of TLF in patients with DM. Conclusion T- or V-stenting in patients with DM resulted in increased cardiovascular events after second-generation DES implantation. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT03068494?term=03068494&draw=2&rank=1, identifier: NCT03068494.
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Affiliation(s)
- Jung-Joon Cha
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea,*Correspondence: Soon Jun Hong ✉
| | - Ju Hyeon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Subin Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Hyung Joon Joo
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jae Hyoung Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyeon-Cheol Gwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, South Korea
| | - Seung-Woon Rha
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Ok Jeong
- Department of Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Jung Ho Heo
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Pusan, South Korea
| | - Junghan Yoon
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong-Seon Park
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, South Korea
| | - Myeong-Ki Hong
- Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan, South Korea
| | - Kwang Soo Cha
- Department of Internal Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Pusan, South Korea
| | - Sang Yeub Lee
- Department of Cardiology, Chung-Ang University, College of Medicine Heart and Brain Hospital, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Kiyuk Chang
- Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Byung-Hee Hwang
- Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - So-Yeon Choi
- Department of Internal Medicine, Ajou University Hospital, Suwon, South Korea
| | - Myung Ho Jeong
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Young Bin Song
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ki Hong Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Do-Sun Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
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Bhogal S, Zhang C, Aladin AI, Mintz GS, Waksman R. Provisional Versus Dual Stenting of Left Main Coronary Artery Bifurcation Lesions (from a Comprehensive Meta-Analysis). Am J Cardiol 2022; 185:10-17. [DOI: 10.1016/j.amjcard.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/24/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022]
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12
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Effect of Stenting Strategy on the Outcome in Patients with Non-Left Main Bifurcation Lesions. J Clin Med 2022; 11:jcm11195658. [PMID: 36233526 PMCID: PMC9571815 DOI: 10.3390/jcm11195658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
Previous studies have not compared outcomes between different percutaneous coronary intervention (PCI) strategies and lesion locations in non-left main (LM) bifurcation lesions. We enrolled 2044 patients from a multicenter registry with an LAD bifurcation lesion (n = 1551) or non-LAD bifurcation lesion (n = 493). The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). During a median follow-up period of 38 months, non-LAD bifurcation lesions treated with the two-stent strategy, compared with the one-stent strategy, were associated with more frequent TLF (20.7% vs. 6.3%, p < 0.01), TLR (16.7% vs. 4.7%, p < 0.01), and target vessel revascularization (TVR; 18.2% vs. 6.3%, p < 0.01). There was no significant difference in outcome among LAD bifurcation lesions treated with different PCI strategies. The two-stent strategy was associated with a higher risk of TLF (adjusted HR 4.34, CI 1.93−9.76, p < 0.01), TLR (adjusted HR 4.30, CI 1.64−11.27, p < 0.01), and TVR (adjusted HR 5.07, CI 1.69−9.74, p < 0.01) in the non-LAD bifurcation lesions. The planned one-stent strategy is preferable to the two-stent strategy for the treatment of non-LAD bifurcation lesions.
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13
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Kang J, Bruno F, Rhee TM, De Luca L, Han JK, de Filippo O, Yang HM, Mattesini A, Park KW, Truffa A, Kim HS, Wojciech W, Gwon HC, Gili S, Chun WJ, Helft G, Hur SH, Cortese B, Han SH, Escaned J, Song YB, Chieffo A, Choi KH, Gallone G, Doh JH, De Ferrari G, Hong SJ, Quadri G, Nam CW, Koo BK, D’Ascenzo F. Impact of Clinical and Lesion Features on Outcomes After Percutaneous Coronary Intervention in Bifurcation Lesions. JACC. ASIA 2022; 2:607-618. [PMID: 36518719 PMCID: PMC9743454 DOI: 10.1016/j.jacasi.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 01/11/2023]
Abstract
Background Bifurcation percutaneous coronary intervention (PCI) is associated with higher risk of clinical events. Objectives This study aimed to determine clinical and lesion features that predict adverse outcomes, and to evaluate the differential prognostic impact of these features in patients undergoing PCI for bifurcation lesions. Methods We analyzed 5,537 patients from the BIFURCAT (comBined Insights From the Unified RAIN and COBIS bifurcAtion regisTries) registry. The primary outcome was major adverse cardiac events (MACE) at 2-year follow-up; secondary outcomes included hard endpoints (all-cause death, myocardial infarction) and lesion-oriented clinical outcomes (LOCO) (target-vessel myocardial infarction, target lesion revascularization). The least absolute shrinkage and selection operator (LASSO) model was used for feature selection. Results During the 2-year follow-up period, MACE occurred in 492 patients (8.9%). The LASSO model identified 5 clinical features (old age, chronic renal disease, diabetes mellitus, current smoking, and left ventricular dysfunction) and 4 lesion features (left main disease, proximal main branch disease, side branch disease, and a small main branch diameter) as significant features that predict MACE. A combination of all 9 features improved the predictive value for MACE compared with clinical and lesion features (area under the receiver-operating characteristics curve: 0.657 vs 0.636 vs 0.581; P < 0.001). For secondary endpoints, the clinical features had a higher impact than lesion features on hard endpoints, whereas lesion features had a higher impact than clinical features on LOCO. Conclusions In bifurcation PCI, 9 features were associated with MACE. Clinical features were predominant predictors for hard endpoints, and lesion features were predominant for predicting LOCO. Clinical and lesion features have distinct values, and both should be considered in bifurcation PCI.
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Affiliation(s)
- Jeehoon Kang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Francesco Bruno
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Tae-min Rhee
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Leonardo De Luca
- Department of Cardiosciences, San Camillo-Forlanini Hospital, Roma, Italy
| | - Jung-Kyu Han
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ovidio de Filippo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Han-Mo Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Kyung Woo Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wanha Wojciech
- Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Hyeon-Cheol Gwon
- Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | | | - Woo Jung Chun
- Department of Internal Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Gerard Helft
- Pierre and Marie Curie University, Paris, France
| | - Seung-Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bernardo Cortese
- Interventional Cardiology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Seung Hwan Han
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Young Bin Song
- Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Alaide Chieffo
- Division of Cardiology, Ospedale San Raffaele, Milan, Italy
| | - Ki Hong Choi
- Department of Cardiology Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Guglielmo Gallone
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Joon-Hyung Doh
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Gaetano De Ferrari
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Giorgio Quadri
- Division of Cardiology, Ospedale di Rivoli, Rivoli, Italy
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea,Address for correspondence: Dr Bon-Kwon Koo, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea.
| | - Fabrizio D’Ascenzo
- Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
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14
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Ayman R, Shaheen SM, Sabet SS, Abdellatif YA. Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian registry. Egypt Heart J 2022; 74:63. [PMID: 36068451 PMCID: PMC9448832 DOI: 10.1186/s43044-022-00302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a “real-world” setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals). Results This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023). Conclusions LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.
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Alasmari A, Iskandar M, Daoulah A, Hersi AS, Alshehri M, Aljohar A, Al Garni T, Abuelatta R, Yousif N, Almahmeed W, Kazim HM, Refaat W, Selim E, Alzahrani B, Alqahtani AH, Ajaz Ghani M, Amin H, Hashmani S, El-Sayed O, Jamjoom A, Hurley WT, Dahdouh Z, Aithal J, Ahmad O, Ramadan M, Ibrahim AM, Elganady A, Qutub MA, Alama MN, Abohasan A, Hassan T, Balghith M, Altnji I, Hussien AF, Abdulhabeeb IAM, Qenawi W, Shawky A, Ghonim AA, Elmahrouk A, Hiremath N, Jameel Naser M, Shawky AM, Lotfi A. One Versus Two Stents Strategies for Unprotected Left Main Intervention: Gulf Left Main Registry. Angiology 2022:33197221121004. [PMID: 35969482 DOI: 10.1177/00033197221121004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The optimal stenting strategy for unprotected left main coronary artery (ULMCA) disease remains debated. This retrospective observational study (Gulf Left Main Registry) analyzed the outcomes of 1 vs 2 stents in patients with unprotected left main percutaneous coronary intervention (PCI). Overall, 1222 patients were evaluated; 173 had 1 stent and 1049 had 2 stents. The 2-stent group was older with more comorbidities, higher mean SYNTAX scores, and more distal bifurcation lesions. In the 1-stent group, in-hospital events were significant for major bleeding, and better mean creatinine clearance. At median follow-up of 20 months, the 1-stent group was more likely to have target lesion revascularization (TLR). Total mortality was numerically lower in the 1-stent group (.00% vs 2.10%); however, this was not statistically significant (P=.068). Our analysis demonstrates the benefits of a 2-stent approach for ULMCA patients with high SYNTAX scores and lesions in both major side branches, while the potential benefit of a 1-stent approach for less complex ULMCA was also observed. Further studies with longer follow-up are needed to definitively demonstrate the optimal approach.
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Affiliation(s)
- Abdulaziz Alasmari
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Mina Iskandar
- Department of Internal Medicine-Pediatrics Residency Program, UMass Chan Medical School, 21645Baystate Medical Center, Springfield, MA, USA
| | - Amin Daoulah
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmad S Hersi
- Department of Cardiac Sciences, 534885King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alshehri
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Alwaleed Aljohar
- Department of Cardiac Sciences, 534885King Fahad Cardiac Center, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Turki Al Garni
- Department of Cardiology, 48077Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Reda Abuelatta
- Department of Cardiology, 363886Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, 144878Kingdom of Bahrain, Bahrain
| | - Wael Almahmeed
- Heart & Vascular Institute, 284697Cleveland Clinic Abu Dhabi, UAE
| | - Hameedullah M Kazim
- Department of Cardiology, 37842Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Wael Refaat
- Department of Cardiology, 204603Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ehab Selim
- Department of Cardiology, 37842Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Badr Alzahrani
- Department of Cardiology, 48077Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman H Alqahtani
- Department of Emergency Medicine,48168King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ajaz Ghani
- Department of Cardiology, 363886Madinah Cardiac Center, Madinah, Kingdom of Saudi Arabia
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Specialist Cardiac Center, Awali, 144878Kingdom of Bahrain, Bahrain
| | | | - Osama El-Sayed
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Jamjoom
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - William T Hurley
- Department of Emergency Medicine, 2569Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, 37852King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Jairam Aithal
- Department of Cardiology, Yas Clinic, Khalifa City A, Abu Dhabi, UAE
| | - Osama Ahmad
- Department of Cardiovascular Medicine, 37852King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohamed Ramadan
- Department of Cardiology, 204603Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Ahmed M Ibrahim
- Department of Cardiology, 48051Saudi German Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdelmaksoud Elganady
- Department of Cardiology, 124911Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed A Qutub
- Cardiology Center of Excellence, Department of Medicine, 37848King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Mohamed N Alama
- Cardiology Center of Excellence, Department of Medicine, 37848King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulwali Abohasan
- Department of Cardiology, 557798Prince Sultan Cardiac Center, Qassim, Kingdom of Saudi Arabia
| | - Taher Hassan
- Department of Cardiology, 48131Bugshan General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- King Abdulaziz Cardiac Center, College of Medicine, 48149King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia
| | - Issam Altnji
- Department of Cardiology, 58005Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Adnan Fathey Hussien
- Department of Cardiology, International Medical Center, Jeddah, Kingdom of Saudi Arabia
| | - Ibrahim A M Abdulhabeeb
- Department of Cardiology, King Abdulaziz Specialist Hospital, Al Jawf, Kingdom of Saudi Arabia
| | - Wael Qenawi
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed Shawky
- Department of Cardiology, Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Ahmed A Ghonim
- Cardiology Center of Excellence, Department of Medicine, 37848King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Ahmed Elmahrouk
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | | | - Maryam Jameel Naser
- Department of Internal Medicine, 21645Baystate Medical Center, Springfield, MA, USA
| | - Abeer M Shawky
- Department of Cardiology, 124911Dr Erfan and Bagedo General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Jang AY, Kim M, Oh PC, Suh SY, Lee K, Kang WC, Choi KH, Song YB, Gwon HC, Kim HS, Chun WJ, Hur SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Hong SJ, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Nam CW, Koo BK, Han SH. Long-Term Clinical Outcomes and Its Predictors Between the 1- and 2-Stent Strategy in Coronary Bifurcation Lesions - A Baseline Clinical and Lesion Characteristic-Matched Analysis. Circ J 2022; 86:1365-1375. [PMID: 35896356 DOI: 10.1253/circj.cj-22-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Differences in the impact of the 1- or 2-stent strategy in similar coronary bifurcation lesion conditions are not well understood. This study investigated the clinical outcomes and its predictors between 1 or 2 stents in propensity score-matched (PSM) complex bifurcation lesions.Methods and Results: We analyzed the data of patients with bifurcation lesions, obtained from a multicenter registry of 2,648 patients (median follow up, 53 months). The patients were treated by second generation drug-eluting stents (DESs). The primary outcome was target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction (TVMI), and ischemia-driven target lesion revascularization (TLR). PSM was performed to balance baseline clinical and angiographic discrepancies between 1 and 2 stents. After PSM (N=333 from each group), the 2-stent group had more TLRs (hazard ratio [HR] 3.14, 95% confidence interval [CI] 1.42-6.97, P=0.005) and fewer hard endpoints (composite of cardiac death and TVMI; HR 0.44, 95% CI 0.19-1.01, P=0.054), which resulted in a similar TLF rate (HR 1.40, 95% CI 0.83-2.37, P=0.209) compared to the 1-stent group. Compared with 1-stent, the 2-stent technique was more frequently associated with less TLF in the presence of main vessel (pinteraction=0.008) and side branch calcification (pinteraction=0.010). CONCLUSIONS The 2-stent strategy should be considered to reduce hard clinical endpoints in complex bifurcation lesions, particularly those with calcifications.
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Minsu Kim
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Pyung Chun Oh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Soon Yong Suh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Kyounghoon Lee
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Medicine, Chungnam National University Hospital
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea
| | - So-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center
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Effect of Wire Jailing at Side Branch in 1-Stent Strategy for Coronary Bifurcation Lesions. JACC Cardiovasc Interv 2022; 15:443-455. [PMID: 35210051 DOI: 10.1016/j.jcin.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study aimed to determine whether side branch (SB) wire jailing before main vessel (MV) stenting could prevent SB occlusion after the 1-stent strategy for bifurcation percutaneous coronary intervention. BACKGROUND The benefits of SB wire jailing in the 1-stent strategy remain unclear. METHODS From the COBIS (Coronary Bifurcation Stenting) III registry, 1,890 patients with bifurcation lesions who underwent the 1-stent strategy using second-generation drug-eluting stents were identified and classified into 2 groups according to the use of SB wire jailing: wire jailing (n = 819) and non-wire jailing (n = 1,071). The incidence of SB occlusion (Thrombolysis In Myocardial Infarction flow grade <3) and target lesion failure (cardiac death, myocardial infarction, or target lesion revascularization) was compared. RESULTS The incidence of final SB occlusion was not significantly different between wire jailing (1.8%) vs non-wire jailing (2.9%; P = 0.182). However, wire jailing at the SB was a significant protective factor for SB occlusion after MV stenting on multivariate analysis and was significantly associated with a lower incidence of SB occlusion in patients with significant stenoses (≥60%) at the SB (5.1% vs 11.3%; odds ratio: 0.42; 95% CI: 0.19-0.89; P = 0.028) or MV (3.1% vs 6.2%; odds ratio: 0.49; 95% CI: 0.24-0.95; P = 0.039). During follow-up (median 52 months), the incidence of target lesion failure was not significantly different between wire jailing and non-wire jailing (7.6% vs 6.3%; P = 0.343). CONCLUSIONS During bifurcation percutaneous coronary intervention with the 1-stent strategy, wire jailing at the SB was associated with a lower rate of final SB occlusion following MV stenting in patients with severe stenoses at the SB or MV but not with overall bifurcation lesions. Long-term clinical outcomes were comparable between the 2 groups.
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18
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Skorupski WJ, Kałużna-Oleksy M, Lesiak M, Araszkiewicz A, Skorupski W, Grajek S, Mitkowski P, Pyda M, Grygier M. Short- and Long-Term Outcomes of Left Main Coronary Artery Stenting in Patients Disqualified from Coronary Artery Bypass Graft Surgery. J Pers Med 2022; 12:jpm12030348. [PMID: 35330348 PMCID: PMC8953089 DOI: 10.3390/jpm12030348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022] Open
Abstract
The study aims to evaluate the short- and long-term outcomes of left main percutaneous coronary interventions (LM PCI) in patients disqualified from coronary artery bypass graft surgery (CABG). We included 459 patients (mean age: 68.4 ± 9.4 years, 24.4% females), with at least 1-year follow-up; 396 patients in whom PCI was offered as an alternative to CABG (Group 1); and 63 patients who were disqualified from CABG by the Heart Team (Group 2). The SYNTAX score (29.1 ± 9.5 vs. 23.2 ± 9.7; p < 0.001) and Euroscore II value (2.72 ± 2.01 vs. 2.15 ± 2.16; p = 0.007) were significantly higher and ejection fraction was significantly lower (46% vs. 51.4%; p < 0.001) in Group 2. Patients in Group 2 more often required complex stenting techniques (33.3% vs. 16.2%; p = 0.001). The procedure success rates were very high and did not differ between groups (100% vs. 99.2%; p = 0.882). We observed no difference in periprocedural complication rates (12.7% vs. 7.8%; p = 0.198), but the long-term all-cause mortality rate was higher in Group 2 (26% vs. 21%; p = 0.031). LM PCI in patients disqualified from CABG is an effective and safe procedure with a low in-hospital complication rate. Long-term results are satisfactory.
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He J, Zhang D, Zhang R, Wang H, Wu S, Feng L, Yin D, Xu B, Dou K. Validation of the V‐RESOLVE (Visual Estimation for Risk prEdiction of Side Branch OccLusion in Coronary Bifurcation interVEntion) score system in unprotected left main bifurcation. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1465-1472. [PMID: 35094485 DOI: 10.1002/ccd.30111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jining He
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyu Wang
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyu Wu
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Feng
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lee JM, Lee SH, Kim J, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi JH, Choi SH, Kim HS, Chun WJ, Nam CW, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Hong SJ, Koo BK, Gwon HC. Ten-Year Trends in Coronary Bifurcation Percutaneous Coronary Intervention: Prognostic Effects of Patient and Lesion Characteristics, Devices, and Techniques. J Am Heart Assoc 2021; 10:e021632. [PMID: 34514841 PMCID: PMC8649555 DOI: 10.1161/jaha.121.021632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10‐year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10‐year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient‐oriented composite outcome (a composite of all‐cause death, myocardial infarction, and any revascularization). During the 10‐year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all P<0.001). The risk of target vessel failure or patient‐oriented composite outcome decreased continuously from 2004 to 2015 (target vessel failure: from 12.3% to 6.9%, log‐rank P<0.001; patient‐oriented composite outcome: from 13.6% to 9.3%, log‐rank P<0.001). The use of a second‐generation drug‐eluting stent and decreased target vessel failure risk in true bifurcation lesions were the major contributors to improved patient prognosis (interaction P values were <0.001 and 0.013, respectively). Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01642992 and NCT03068494.
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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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22
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Giustino G, Stone GW. Provisional Stenting of Coronary Bifurcations. JACC: ASIA 2021; 1:65-67. [PMID: 36338360 PMCID: PMC9627902 DOI: 10.1016/j.jacasi.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gennaro Giustino
- Zena and Michael A. Wiener Cardiovascular Institute, the Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregg W. Stone
- Zena and Michael A. Wiener Cardiovascular Institute, the Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Cardiovascular Research Foundation, New York, New York, USA
- Address for correspondence: Dr Gregg W. Stone, Mount Sinai Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, New York 10019, USA. @GreggWStone
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Choi KH, Song YB, Lee JM, Park TK, Yang JH, Hahn JY, Choi JH, Choi SH, Kim HS, Chun WJ, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Hong SJ, Nam CW, Koo BK, Gwon HC. Differential Long-Term Effects of First- and Second-Generation DES in Patients With Bifurcation Lesions Undergoing PCI. JACC. ASIA 2021; 1:68-79. [PMID: 36338362 PMCID: PMC9627880 DOI: 10.1016/j.jacasi.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a paucity of data regarding the long-term clinical outcomes of first- versus second-generation drug-eluting stent (DES), especially when used to treat complex lesions such as bifurcation lesions. OBJECTIVES The current study compares the efficacy and safety of first- versus second-generation DES at the 5-year follow-up in patients who underwent bifurcation percutaneous coronary intervention (PCI). METHODS A total of 5,498 patients with a bifurcation lesion who underwent PCI were pooled at a single patient level from COBIS (Coronary Bifurcation Stenting) registries II and III. Five-year target lesion failure (TLF) (the composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and cardiac death or MI were compared between the use of first-generation DES (n = 2,436) and second-generation DES (n = 3,062) during PCI. Propensity score matching was performed to reduce selection bias. RESULTS After a 1:1 propensity score matching procedure was conducted, the cohort consisted of 1,702 matched pairs. Patients treated with second-generation DES had a significantly lower risk of TLF at 5 years than those treated with first-generation DES in both overall and propensity-matched populations (matched hazard ratio [HRmatched]: 0.576; 95% confidence interval [CI]: 0.456 to 0.727; p <0.001). There were no significant differences in risk of a composite of cardiac death or MI between the 2 groups (HRmatched: 0.782; 95% CI: 0.539 to 1.133, P = 0.193). However, among patients who required a 2-stent technique, use of the second-generation DES reduced cardiac death or MI (HRmatched:0.422; 95% CI: 0.209 to 0.851, P = 0.016). On the other hand, among patients who required a one-stent technique, the risk of a composite of cardiac death or MI was similar between the 2 groups (HRmatched: 1.046; 95% CI: 0.664 to 1.650, P = 0.845). There was a significant interaction between stent generation and treatment strategy for cardiac death or MI (interaction P = 0.029). CONCLUSIONS In patients treated with PCI for a bifurcation lesion, the use of second-generation DES was associated with a significantly reduced risk of 5-year TLF than the use of first-generation DES. (Korean Coronary Bifurcation Stenting Registry II [NCT01642992]; COBIS II) (Korean Coronary Bifurcation Stenting Registry III [NCT03068494] COBIS III).
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Affiliation(s)
- Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Jung Chun
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Republic of Korea
| | - Seung-Woon Rha
- Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jung Ho Heo
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Do-Sun Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jong-Seon Park
- Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon-Hyung Doh
- Division of Cardiology, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Kwang Soo Cha
- Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Goyang, Republic of Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Hee Hwang
- Division of Cardiology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Choi
- Division of Cardiology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Soon-Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Hildick-Smith D, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, Wlodarczak A, Pan M, Schmitz T, Silvestri M, Erglis A, Kretov E, Lassen JF, Chieffo A, Lefèvre T, Burzotta F, Cockburn J, Darremont O, Stankovic G, Morice MC, Louvard Y. The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN). Eur Heart J 2021; 42:3829-3839. [PMID: 34002215 DOI: 10.1093/eurheartj/ehab283] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/17/2021] [Accepted: 05/09/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients with non-left-main coronary bifurcation lesions are usually best treated with a stepwise provisional approach. However, patients with true left main stem bifurcation lesions have been shown in one dedicated randomized study to benefit from systematic dual stent implantation. METHODS AND RESULTS Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were aged 71 ± 10 years; 77% were male. Patients were randomly allocated to a stepwise layered provisional strategy (n = 230) or a systematic dual stent approach (n = 237). The primary endpoint (a composite of death, myocardial infarction, and target lesion revascularization at 12 months) occurred in 14.7% of the stepwise provisional group vs. 17.7% of the systematic dual stent group (hazard ratio 0.8, 95% confidence interval 0.5-1.3; P = 0.34). Secondary endpoints were death (3.0% vs. 4.2%, P = 0.48), myocardial infarction (10.0% vs. 10.1%, P = 0.91), target lesion revascularization (6.1% vs. 9.3%, P = 0.16), and stent thrombosis (1.7% vs. 1.3%, P = 0.90), respectively. Procedure time, X-ray dose and consumables favoured the stepwise provisional approach. Symptomatic improvement was excellent and equal in each group. CONCLUSIONS Among patients with true bifurcation left main stem stenosis requiring intervention, fewer major adverse cardiac events occurred with a stepwise layered provisional approach than with planned dual stenting, although the difference was not statistically significant. The stepwise provisional strategy should remain the default for distal left main stem bifurcation intervention. STUDY REGISTRATION http://clinicaltrials.gov NCT02497014.
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Affiliation(s)
- David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | | | | | | | - Miroslaw Ferenc
- Universitäts-Herzzentrum Bad Krozingem, Bad Krozingen, Germany
| | | | | | - Manuel Pan
- Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | | | | | | | - Evgeny Kretov
- Sibirskiy Fеdеrаl Biomedical Research Center Novosibirsk, Novosibirsk, Russia
| | | | | | | | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK
| | - Olivier Darremont
- Clinique Saint-Augustin-Elsan, 114 Avenue d'Arès, Bordeaux 33200, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Centre of Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Yves Louvard
- Institute Cardiovasculaire Paris Sud, Massy, France
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Rigatelli G, Zuin M, Vassilev D, Mazza A, Bilato C, Roncon L. Pooled prevalence of three major cardiovascular risk factors in patients undergoing left main bifurcation stenting: a systematic review and meta-analysis. Minerva Cardiol Angiol 2021; 70:56-64. [PMID: 33944537 DOI: 10.23736/s2724-5683.21.05666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prevalence of the major risk factors in patients with Left Main (LM) bifurcation disease has not been yet clearly assessed, although it would important for building up bifurcation computational models. We perform a systematic review and metaanalysis on the three major cardiovascular risk factors in patients treated for LM bifurcation disease using either single or 2-stent strategy. MEHTODS In accordance with the PRISMA guidelines, Cochrane Library, Embase, PubMed and Google Scholar were queried to locate articles published between January 2015 to October 2020, comparing single- versus 2-stent strategy and reporting the prevalence of arterial hypertension (HT), hyperlipidaemia (HyperL) and diabetes mellitus (DM). RESULTS Out of a total of 230 articles, 7 articles were included into the final analysis. A total of 4559 patients were enrolled: 2666 (58.4%, mean age 60.4 years, 2318 males) and 1933 patients (42.3%, mean age 64.8 years, 1763 males) received a single- and 2-stent stenting strategies, respectively. A random effect model revealed a pooled prevalence of HT, HyperL and DM in 69.4%, 38.9% and in 31% of cases, respectively. Prevalence of HT was lower in patients treated with single versus 2-stent strategy (63 versus 66.7% of patients, p=0.01) while HyperL and DM were more represented in single versus 2-stent strategy: 41.6 versus 34.1% (p<0.001), and 32.5 versus 31.8% of patients (p=0.61), respectively. CONCLUSIONS In patients with LM bifurcation disease undergoing either single or 2- stent strategy, HT, HyperL and DM are frequent comorbidities. In severe LM disease requiring 2-stent technique, HT is the most prevalent risk factor.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy -
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Dobrin Vassilev
- Department of Cardiology, Alexandrovska University School of Medicine, Sofia, Bulgaria
| | - Alberto Mazza
- Hypertension Management Centre of Excellence, Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | - Loris Roncon
- Division of Cardiology, Rovigo General Hospital, Rovigo, Italy
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One- and 3-year outcomes of percutaneous bifurcation left main revascularization with modern drug-eluting stents: a systematic review and meta-analysis. Clin Res Cardiol 2020; 110:1-11. [PMID: 32474643 DOI: 10.1007/s00392-020-01679-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
AIMS Optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. We performed systematic review and meta-analysis comparing one and 3-year clinical outcomes of 1- and 2- stent strategies using modern drug eluting stents (DESs) for revascularization of LM bifurcation disease. METHODS We systematically identified all investigations published between January 2015 and February 2020 comparing the use of single versus double-stent strategies for the revascularization of LM bifurcation lesions. The primary endpoint was 1- and 3-years all-cause mortality. Secondary outcomes included target lesion revascularization (TLR), target lesion failure (TLF), major adverse cardiovascular vents (MACEs) and cardiovascular (CV) mortality while the tertiary outcome was overall occurrence of stent thrombosis (ST) at 1- and 3-years. RESULTS No significant differences were observed between the two groups in terms of all-cause mortality rate both at 1 and 3-year follow-up. Single stent strategy was associated with a significantly lower risk of TLR (OR 0.78, 95% CI 0.62- 0.97, p = 0.03, I2 = 61%) as well as of MACEs (OR 0.78, 95% CI 0.63-0.97, I2 = 24%) compared to 2-stent strategy. Conversely no significant differences between the two groups were observed in terms of TLF, CV mortality and ST during the same follow-up period. CONCLUSIONS In patients with LM bifurcation disease, single stent strategy demonstrated lower rate of MACEs and TLR but was not superior to 2-stent strategy in terms of CV mortality, TLF and ST at 1 and 3-year follow-up.
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Kandzari DE. Less Is More, but Is More Less? Circ Cardiovasc Interv 2020; 13:e008919. [PMID: 32069104 DOI: 10.1161/circinterventions.120.008919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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