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Published on: March 26, 2018
Long-term cardiovascular outcomes after mini-crush or T and minimal protrusion techniques in complex bifurcation
Ahmet Güner1, Fatih Uzun1, Ahmet Yaşar Çizgici1
1Department of Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul.
Insights
The mini-crush (MC) technique demonstrated superior long-term outcomes compared to the T-stenting and small protrusion (TAP) technique for complex bifurcation lesions. MC significantly reduced major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary intervention.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Biomedical Engineering
Background:
- Complex bifurcation lesions (CBLs) pose significant challenges in percutaneous coronary intervention (PCI).
- The mini-crush (MC) and T-stenting and small protrusion (TAP) techniques are commonly employed for CBLs.
- Long-term comparative data on MC versus TAP for CBLs remain limited and debated.
Purpose of the Study:
- To retrospectively evaluate and compare the long-term clinical outcomes of MC and TAP techniques in patients with CBLs.
- To determine the safety and efficacy of each technique in managing complex coronary bifurcations.
Main Methods:
- A retrospective analysis of 271 patients who underwent PCI for CBLs between 2014 and 2023.
- Patients were treated with either the MC technique (n=146) or the TAP technique (n=125).
- The primary endpoint was major adverse cardiovascular events (MACE), including cardiac death, target vessel MI, and clinically driven TLR, analyzed using Cox proportional hazard models with inverse probability weighting.
Main Results:
- The MC group exhibited significantly lower incidence of MACE (13% vs. 26.4%, P=0.005) and major cardiovascular and cerebral events (15.1% vs. 28.8%, P=0.006) compared to the TAP group.
- Long-term MACE was significantly higher in the TAP group (adjusted hazard ratio: 1.936, P=0.033).
- While stent thrombosis was numerically lower in the MC group, the difference was not statistically significant (2.7% vs. 8%, P=0.059).
Conclusions:
- Percutaneous coronary intervention using the mini-crush (MC) technique is associated with superior long-term outcomes compared to the T-stenting and small protrusion (TAP) technique in patients with complex bifurcation lesions.
- The MC technique offers a potentially safer and more effective strategy for managing complex bifurcation lesions, warranting further prospective investigation.
Background:
Mini-crush (MC) and T-stenting and small protrusion (TAP) techniques are frequently used, but the long-term comparison of both techniques in patients with complex bifurcation lesions (CBLs) is still a debatable issue. This study sought to retrospectively evaluate the long-term outcomes of MC and TAP techniques in patients with CBLs.
Methods:
A total of 271 patients [male: 202 (78.9%), mean age: 58.90 ± 10.11 years] patients in whom complex bifurcation intervention was performed between 2014 and 2023 were involved. The primary endpoint was major cardiovascular events (MACE) as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization. The Cox proportional hazard models were adjusted by the inverse probability weighting approach to reduce treatment selection bias.
Results:
The initial management strategy was MC in 146 patients and TAP in 125 cases. MACE occurred in 52 patients (19.2%) during a mean follow-up period of 32.43 ± 16 months. The incidence of MACE (13 vs. 26.4%, P = 0.005) and major cardiovascular and cerebral events (15.1 vs. 28.8%, P = 0.006) were significantly lower in the MC group than in the TAP group. Additionally, the incidence of definite or probable stent thrombosis was numerically lower in the MC group compared with the TAP group but did not differ significantly (2.7 vs. 8%, P = 0.059). The long-term MACE was notably higher in the TAP group than the MC group [adjusted hazard ratio (inverse probability weighted): 1.936 (95% confidence interval: 1.053-3.561), P = 0.033].
Conclusion:
In this study involving patients with CBLs, percutaneous coronary intervention with the MC technique had better long-term outcomes than the TAP technique.
