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Navigating MARRVEL, a Web-Based Tool that Integrates Human Genomics and Model Organism Genetics Information
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Decoding medina 0.0.1 bifurcation: Are all codes equal? Results from a multicentric registry.

Matteo Maurina1, Maya Riche2, Omar Oliva3

  • 1Department of Biomedical Sciences, Humanitas University, Milan, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy; Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands.

International Journal of Cardiology
|November 28, 2024
PubMed
Summary

Medina 0.0.1 bifurcations have high rates of Major Adverse Cardiovascular Events (MACE) and Target Lesion Revascularization (TLR). Diabetes is the sole independent predictor of 3-year MACE in these rare lesions.

Keywords:
Bifurcation lesionsMACEMedina 0–0-1PCIPOTProvisional stenting

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Medina 0.0.1 bifurcations represent a rare and understudied subset of coronary artery disease.
  • Optimal treatment strategies for these lesions remain debated and lack comprehensive description in clinical practice.

Purpose of the Study:

  • To elucidate the technical management of Medina 0.0.1 lesions.
  • To evaluate the clinical outcomes associated with these lesions.
  • To identify predictors of Major Adverse Cardiovascular Events (MACE).

Main Methods:

  • A multicenter international registry included 273 patients with 277 de novo Medina 0.0.1 lesions treated with percutaneous coronary intervention (PCI) between 2017 and 2022.
  • Systematic data collection and clinical follow-up were performed, with a primary endpoint of 3-year MACE.
  • Secondary endpoints included Target Lesion Revascularization (TLR) and stent thrombosis.

Main Results:

  • The median follow-up was 1180 days. Most lesions (84.1%) were treated with a single stent, primarily using inverted provisional (53.6%) or ostial stenting (45.9%).
  • The 3-year incidence of MACE was 16.9%, and TLR was 13.4%.
  • Diabetes was identified as the only independent predictor of 3-year MACE (adjusted HR 2.35, p=0.01). Proximal optimization technique use was associated with significantly reduced MACE (HR 0.28, p=0.03).

Conclusions:

  • Medina 0.0.1 bifurcations are associated with substantial long-term MACE and TLR rates.
  • Diabetes mellitus is the primary independent risk factor for adverse outcomes in this patient cohort.
  • Adherence to current guidelines for bifurcation angioplasty is inconsistent, particularly for smaller bifurcations and in acute settings.