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Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome
Pablo Salinas1, Hernán Mejía-Rentería1, Raúl Herrera-Nogueira1
1Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
Insights
Primary angioplasty for bifurcation culprit lesions (BCL) in ST-segment elevation myocardial infarction is technically complex but yields similar long-term outcomes. This study found no significant differences in major adverse events between BCL and non-BCL patients at 5 years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring prompt reperfusion.
- Coronary artery bifurcation lesions (BCL) present unique challenges in percutaneous coronary intervention (PCI).
- Assessing the outcomes of PCI in BCL is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare short- and long-term outcomes of primary angioplasty in STEMI patients with bifurcation culprit lesions (BCL) versus non-BCL.
- To evaluate the technical complexity and clinical efficacy of PCI in BCL.
- To determine if BCL impacts patient prognosis after primary angioplasty.
Main Methods:
- An observational study utilizing propensity score matching (1:1) of 274 STEMI patients with BCL against a control group.
- The primary composite endpoint included all-cause death, myocardial infarction, coronary artery bypass grafting, or target vessel revascularization.
- Outcomes were assessed at 30 days and 5 years post-procedure.
Main Results:
- Procedures for BCL were technically more complex, requiring more balloon dilatations, longer procedural times, and increased contrast use compared to non-BCL.
- Despite technical complexity, main branch angiographic success rates were similar between BCL (93.4%) and non-BCL (93.8%) groups.
- No significant differences were observed in 30-day all-cause mortality (4.7% vs 5.1%) or 5-year outcomes, including all-cause death (12% vs 13%) and the composite endpoint (22% vs 21%).
Conclusions:
- Primary angioplasty for bifurcation culprit lesions in STEMI is feasible and safe.
- While technically more demanding, PCI of BCL achieves comparable angiographic success and long-term clinical outcomes to non-BCL.
- These findings support current interventional strategies for managing STEMI patients with BCL.
Introduction And Objectives:
We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL.
Methods:
Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years.
Results:
Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29minutes BCL vs 62.8 ± 28.9minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9mL BCL vs 221.1 ± 82.3mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43).
Conclusions:
Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients.
