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Coronary bifurcation angle from 3-D predicts clinical outcomes after stenting bifurcation lesions
Shao-Liang Chen1, Teguh Santoso, Jun-Jie Zhang
1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. chmengx@126.com
Insights
The two-stent technique significantly reduces distal bifurcation angle (BA) after stenting, lowering major adverse cardiac events (MACE) in patients with smaller baseline BA (<60°). This approach is crucial for optimizing outcomes in coronary bifurcation stenting.
Area of Science:
- Interventional Cardiology
- Biomedical Engineering
- Quantitative Coronary Analysis
Background:
- The predictive value of bifurcation angle (BA) for adverse events after stenting coronary bifurcation lesions is not well understood.
- Investigating the dynamic changes in BA and its clinical relevance in patients undergoing drug-eluting stent (DES) implantation for bifurcation lesions is essential.
Purpose of the Study:
- To investigate the dynamic changes in bifurcation angle (BA) after stenting coronary bifurcation lesions.
- To assess the clinical relevance of these BA changes and their association with major adverse cardiac events (MACE).
Main Methods:
- Bifurcation angle (BA) was calculated using 3-D quantitative coronary analysis in 347 patients from the DKCRUSH-II study.
- The primary endpoint was the composite of major adverse cardiac events (MACE) at 12 months, including cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).
- Secondary endpoints included binary restenosis and stent thrombosis rates at 12 months.
Main Results:
- Stenting reduced the distal BA, with a cutoff value of 60° predicting MACE.
- The two-stent technique significantly reduced distal BA compared to the single-stent technique, especially in the <60° group.
- The one-stent technique was associated with higher rates of target lesion revascularization (TLR), TVR, and MACE compared to the two-stent technique, particularly in the <60° BA group.
Conclusions:
- The two-stent technique effectively reduces distal BA in coronary bifurcation stenting.
- DK crush stenting is associated with a reduced MACE rate in patients with a baseline BA <60°, compared to single-stent techniques.
- Distal BA reduction after stenting is technique-dependent and clinically relevant for predicting adverse events.
Background:
The predictive value of bifurcation angle (BA) for worse events after stenting bifurcation lesions remains to be unknown. The present study was to investigate the dynamic change of BA and clinical relevance for patients with coronary bifurcation lesions treated by drug-eluting stent (DES).
Methods:
BA was calculated by 3-D quantitative coronary analysis from 347 patients in DKCRUSH-II study. Primary endpoint was the occurrence of composite major adverse cardiac events (MACE) at 12-month, including cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR). Secondary end points were the rate of binary restenosis and stent thrombosis at 12-month.
Results:
Stenting was associated with the reduction of distal BA. The cut-off value of distal BA for predicting MACE was 60°. Distal BA in < 60° group had less reduction after stenting ((-1.96 ± 13.58)° vs. (-12.12 ± 23.58)°, P < 0.001); two-stent technique was associated with significant reduction of distal BA (Δ(-4.05 ± 14.20)°), compared to single stent group (Δ + 1.55 ± 11.73, P = 0.003); the target lesion revascularization (TLR), TVR and MACE rate was higher in one-stent group (16.5%, 19.0% and 21.5%), compared to two-stent group (3.8%, P = 0.002; 7.5%, P = 0.016; and 9.8%, P = 0.024), respectively. Among patients in ≥ 60° group, there were no significant differences in distal BA, stent thrombosis (ST), MI, MACE, death, TLR, TVR between one- and two-stent groups; after stenting procedure, there was only slight change of distal BA in left anterior descending (LAD)-left circumflex (LCX) subgroup (from (88.54 ± 21.33)° at baseline to (82.44 ± 31.72)° post-stenting), compared to either LAD-diagonal branch (Di), or LCX-obtuse marginal branch (OM), or RCA distal (RCAd) (all P < 0.001).
Conclusion:
Two-stent technique was associated with significant reduction of distal BA. DK crush stenting had reduced rate of MACE in patients in < 60° group, compared to one-stent technique.
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