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Published on: May 14, 2013
Long-term outcome of bifurcation stenting with drug-eluting stents
Yumiko Kanei1, Navin C Nakra, Yili Huang
1Division of Cardiology, Department of Medicine, Beth Israel Medical Center, New York, NY 10003, USA. yumikanei@hotmail.com
Insights
Treating coronary bifurcation lesions with two drug-eluting stents (DESs) showed acceptable major adverse cardiac events (MACEs) rates. Long-term data indicate this approach is safe and effective when necessary for complex cases.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Limited long-term clinical data exist on the safety and efficacy of using two drug-eluting stents (DESs) for coronary bifurcation lesions.
- Coronary artery disease often involves complex bifurcation lesions requiring advanced stenting techniques.
Purpose of the Study:
- To evaluate the long-term safety and efficacy of treating coronary bifurcation lesions with two DESs.
- To assess the rate of major adverse cardiac events (MACEs) in patients undergoing two-stent bifurcation procedures.
Main Methods:
- A retrospective analysis of 124 consecutive patients who underwent bifurcation stenting with two DESs.
- Clinical follow-up was obtained to record MACEs, defined as cardiac death, acute myocardial infarction (AMI), and target vessel revascularization (TVR).
- Patients were categorized by stenting technique: crush, T stent, or kissing stent.
Main Results:
- At one year, 17% of patients experienced MACEs (6% AMI, 12% TVR, 0% death).
- At a mean follow-up of 22 months, 26% experienced MACEs (6% AMI, 19% TVR, 1% death).
- No statistically significant risk factors for long-term MACEs were identified.
Conclusions:
- Treating coronary bifurcation lesions with two DESs, when indicated, can be performed with an acceptable MACE rate.
- The study suggests that two-stent strategies for bifurcation lesions are a viable option with manageable long-term outcomes.
- Further research may refine patient selection and procedural techniques for optimal results.
Abstract:
There are little long-term clinical data regarding the safety and efficacy of using 2 drug-eluting stents (DESs) to treat coronary bifurcation lesions. We obtained clinical follow-up for 124 consecutive patients who underwent bifurcation stenting with 2 DESs. Major adverse cardiac events (MACEs) were defined as cardiac death, acute myocardial infarction (AMI), and target vessel revascularization (TVR). Sixty-four (52%) patients underwent ''crush,'' 42 (34%) patients underwent T stent, and 18 (14%) patients underwent kissing stent. Major adverse cardiac events were observed in 19 patients (17%) at 1 year: 6 (5%) AMI, 13 (12%) TVR, and no deaths, and 29 patients (26 %) at a mean follow-up of 22 months: 7 (6%) AMI, 21 (19%) TVR, and 1 (1%) death. No statistically significant risk factors for long-term MACEs were identified. It appears that treating bifurcation lesions with 2 DESs when necessary can be performed with an acceptable MACE rate.
