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Immediate, Short-Term, Intermediate, and Long-Term Clinical Outcomes of True Bifurcation Stenting
Mamoon Qadir1, Anwar Ali2, Fahad Khalid3
1Interventional Cardiology, Fellowship of the Royal College of Physicians (FRCP, UK) Kulsum International Hospital, Polyclinic Hospital Islamabad, Islamabad, PAK.
Insights
The two-stent strategy for coronary artery bifurcation lesions shows good long-term outcomes and low complication rates, offering an effective treatment option for these high-risk patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery bifurcation lesions present higher risks than non-bifurcation lesions.
- These lesions can negatively impact patient prognosis and increase adverse event rates.
Purpose of the Study:
- To evaluate the clinical efficacy of various stenting techniques for true bifurcation lesions.
- To assess immediate, short-term, intermediate, and long-term outcomes associated with these techniques.
Main Methods:
- Retrospective observational cohort study (February 2015 - February 2021).
- 172 patients with true bifurcation lesions undergoing percutaneous coronary intervention (PCI).
- Three-year follow-up to evaluate procedural outcomes.
Main Results:
- Drug-eluting stents demonstrated good procedural success.
- Major adverse cardiac events (MACE) were significantly associated with acute coronary syndrome (ACS) and prior PCI (p < 0.000).
- Final kissing balloon inflation, stenting technique, and bifurcation involvement correlated with MACE (p < 0.01); mortality was 1.16%.
Conclusions:
- The two-stent strategy is a viable option for true bifurcation lesions.
- This approach yields favorable long-term outcomes with a low rate of complications.
Introduction:
Coronary artery bifurcation lesion is an epicardial stenosis that, when compared to non-bifurcation lesions, poses a greater risk of adverse events and can compromise prognosis. This study aims to investigate the clinical efficacy of different stenting techniques, particularly in terms of their immediate, short-term, intermediate, and long-term outcomes in patients with true bifurcation lesions.
Methodology:
This retrospective observational cohort study was conducted in a tertiary cardiac hospital in Islamabad, from February 1, 2015, to February 28, 2021. A total of 172 patients who met the inclusion criteria and underwent percutaneous coronary intervention were selected using a consecutive sampling technique. Follow-up was maintained for three years to assess procedural outcomes.
Results:
Of the 172 participants, the majority were males (69%) and only 4% were above 75 years of age. A significant relation between major adverse cardiac events (MACEs) with acute coronary syndrome (ACS) and previous percutaneous coronary intervention (PCI) (p < 0.000) was observed. Procedural success was good in all patients using the drug-eluting stent. The MAC rate was 6.9% and the final kissing balloon inflation, stenting technique, and bifurcation involvement were significantly associated with MACE occurrence (p < 0.01), and mortality was reported in two patients (1.16%). MACEs were associated with mortality; previous PCI and hypertension increased the risk of mortality.
Conclusion:
The two-stent strategy can be used with good long-term outcomes and low complication rates.
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