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Very long-term results comparing a simple versus a complex stenting strategy in the treatment of coronary bifurcation
Imad Sheiban1, Vincenzo Andrea Infantino, Francesco Colombo
1Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista Molinette Hospital, Turin, Italy.
Insights
Both simple and complex stenting strategies for coronary bifurcation lesions demonstrate favorable long-term clinical outcomes. This study found low rates of major adverse cardiac events (MACE) for both approaches, supporting their efficacy.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- The optimal stenting strategy for coronary bifurcation lesions remains undefined, particularly lacking very long-term (>24 months) data.
- This study addresses the need for long-term outcome comparisons between simple and complex stenting techniques in bifurcation lesions.
Purpose of the Study:
- To compare the long-term clinical results of simple versus complex stenting strategies in patients with coronary bifurcation lesions.
- To evaluate the rate of major adverse cardiac events (MACE) beyond 24 months following intervention.
Main Methods:
- Retrospective analysis of 326 patients undergoing percutaneous coronary intervention (PCI) with stenting for bifurcation lesions (June 2002-December 2005).
- Patients were categorized into two groups: simple stenting technique (Group A) and complex stenting strategy (Group B).
- Primary endpoint was MACE at >24 months follow-up; secondary endpoints included cardiac death, myocardial infarction, target vessel revascularization, and stent thrombosis.
Main Results:
- No significant difference in MACE rates between simple (26.5%) and complex (31.4%) strategies at a median of 34 months (P=0.37).
- Target vessel revascularization was higher in the complex strategy group (28.4%) compared to the simple group (18.4%) (P=0.04).
- Both strategies showed low rates of cardiac death, myocardial infarction, and definite stent thrombosis, with procedural success rates above 99% for both.
Conclusions:
- Both simple and complex stenting strategies are associated with favorable long-term clinical results for coronary bifurcation lesions.
- The study indicates low rates of adverse events for both techniques, suggesting that either approach can be effective.
- Further research may be warranted to explore specific patient or lesion characteristics that might favor one strategy over the other.
Background:
The optimal stenting strategy for coronary bifurcation lesions has not yet been defined, especially given the lack of very long-term data (>24 months). We compared our long-term results of a simple vs complex stenting strategy in patients with bifurcation lesions.
Methods:
We retrospectively selected subjects undergoing percutaneous coronary intervention (PCI) with stenting in a bifurcation lesion between June 2002 and December 2005, comparing those treated with a simple technique vs those treated with a complex one. The primary end-point was the rate of major adverse cardiac events (MACE) at >24 months of follow-up.
Results:
A total of 326 patients were included, 64.7% treated with a simple technique (Group A) and 35.3% with a complex strategy (Group B). Drug-eluting stents were used in 82.0% and 73.0%, respectively (P = 0.059), final kissing balloon in 47.9% and 53.0% (P = 0.37), and procedural success obtained in 99.5% and 99.1% (P = 0.66). After a median of 34 months, MACE occurred in 52 (26.5%) in Group A and in 32 (31.4%) in Group B (P = 0.37), cardiac death in six (3.1%) vs four (3.9%, P = 0.70), myocardial infarction in 13 (6.6%) vs 6 (5.9%, P = 0.80), target vessel revascularization in 36 (18.4%) vs 29 (28.4%, P = 0.04), and bypass in five (2.6%) vs two (2%, P = 0.74). Definite stent thrombosis was adjudicated in two (1%) vs one (0.9%, P = 0.98).
Conclusions:
This study, comparing simple and complex stenting strategies for the treatment of coronary bifurcation lesions, shows that both techniques are associated with favorable clinical results and low adverse events rates at long-term follow-up.
