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Impact of side-branch flow in coronary bifurcation intervention
Hamid Reza Poorhosseini1, Seyed Ebrahim Kassaian, Seyed Kianoosh Hosseini
1Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
For coronary artery bifurcation lesions, a simple main vessel stenting strategy is as effective as complex main vessel and side branch intervention. Both approaches showed similar rates of major adverse cardiac events over 12 months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Optimal percutaneous coronary intervention (PCI) strategy for coronary artery bifurcation lesions remains debated.
- Comparison of main vessel (MV) stenting for side branch (SB) perfusion versus MV + SB intervention is crucial.
Purpose of the Study:
- To compare the efficacy of a simplified PCI strategy (MV stenting) with a complex strategy (MV + SB intervention) for bifurcation lesions.
- To evaluate major adverse cardiac events (MACE) in patients undergoing PCI for bifurcation lesions.
Main Methods:
- Retrospective analysis of 258 consecutive patients with bifurcation lesions undergoing PCI.
- Follow-up of patients for 12 months to assess MACE (cardiac death, myocardial infarction, target-vessel/lesion revascularization).
Main Results:
- 52.7% of patients received MV stenting, and 47.3% underwent MV + SB intervention.
- Overall MACE rate was 4.3% (11 patients) over 12 months.
- No significant difference in MACE rates between MV (3.7%) and MV + SB (4.9%) groups (p=0.622).
Conclusions:
- A simple PCI strategy focusing on MV stenting for TIMI-III flow in the SB is not associated with increased MACE compared to complex MV + SB intervention.
- The choice between simple and complex PCI strategies for coronary bifurcation lesions does not impact MACE when TIMI-III flow is the goal.
Background:
The optimal strategy in percutaneous coronary intervention (PCI) for coronary artery bifurcation lesions has yet to be agreed upon. We compared a strategy for stenting the main vessel to provide a complete perfusion flow in the side branch, namely thrombolysis in myocardial infarction (TIMI) - III, with a strategy for intervention in both the main vessel and the side branch (MV + SB).
Methods:
This retrospective study utilized data on 258 consecutive patients with bifurcation lesions scheduled for PCI at Tehran Heart Center between March 2003 and March 2008. The patients were followed up for 12 months, and the primary end point was a major adverse cardiac event (MACE), i.e. cardiac death, myocardial infarction, target-vessel revascularization, and target-lesion revascularization during the 12-month follow-up period.
Results:
A total of 52.7% of the patients underwent PCI on the main vessel of the bifurcation lesions (MV group) and 47.3% with a similar lesion type received a percutaneous intervention on both the main vessel and the side branch (MV + SB group). The total rate of MACE during the follow-up was 4.3% (11 patients); the rate was not significantly different between the MV and MV + SB groups (3.7% vs. 4.9%, respectively; p value = 0.622).
Conclusion:
There was no association between MACE in performing a simple or complex interventional strategy to treat coronary bifurcation lesions when drawing the TIMI- III flow as a goal in a simple technique.
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