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Predictors and Outcomes of Occlusion of Jailed Side Branches Following Main Vessel Coronary Artery Stenting
Tarek A N Ahmed1, Ahmed A Mekawy2, Amr A Youssef2
1Department of Cardiovascular Medicine, Faculty of Medicine, Assiut University Heart Hospital, Assiut, Egypt. tarek.a.n.ahmed@med.aun.edu.eg.
Insights
Predicting side branch occlusion (SBO) during percutaneous coronary intervention for bifurcation lesions (BLs) can be improved. Combining the RESOLVE score with true BLs and high thrombus burden offers better prediction of SBO and subsequent cardiovascular events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Percutaneous coronary intervention (PCI) for coronary bifurcation lesions (BLs) presents technical challenges.
- Significant side branch occlusion (SBO) is a potential complication during PCI of BLs.
Purpose of the Study:
- To evaluate the predictive value of additional lesion characteristics for SBO.
- To assess if combining these characteristics with the RESOLVE score improves SBO prediction.
Main Methods:
- Observational study of 510 patients undergoing PCI for coronary BLs.
- Data collected included quantitative coronary angiography and procedural details.
- The RESOLVE score was calculated, and SBO was defined as impaired SB flow post-stenting.
Main Results:
- SBO occurred in 19.6% of BLs.
- Independent predictors of SBO included true BLs, high thrombus burden, and a high RESOLVE score.
- A model combining true BLs, high thrombus burden, and RESOLVE score demonstrated superior discrimination for SBO compared to the RESOLVE score alone.
Conclusions:
- A predictive model incorporating true BLs, high thrombus burden, and the RESOLVE score enhances SBO prediction.
- SBO is associated with increased in-hospital and 6-month major adverse cardiovascular events (MACE).
Background And Objectives:
Percutaneous interventions of coronary bifurcation lesions (BLs) remain technically challenging with possible complications including significant side branch (SB) occlusion (SBO). We aimed to assess the predictive value of additional lesion characteristics to the RESOLVE (Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion)-score for prediction of SBO.
Methods:
This observational study included patients with coronary BLs subtending sizable SB (≥2 mm in diameter), planned for provisional stenting. SBO was defined as impairment of SB flow after main vessel stenting. Quantitative coronary angiographic and procedural data were recorded, and the RESOLVE-score was calculated for all BLs. In-hospital and 6-month major adverse cardiovascular events (MACE) were reported.
Results:
The study included 510 patients with 556 BLs. SBO occurred among 107 patients (21.0%) involving 109 BLs (19.6%). True BLs (odds ratio [OR], 6.05; 95% confidence interval [CI], 3.07-11.91; p<0.001), high thrombus burden (OR, 2.88; 95% CI, 1.56-5.31; p=0.001), and high RESOLVE-score (OR, 3.41; 95% CI, 1.85-6.28, p<0.001) were the only independent predictors of SBO among lesion-related variables. Combined true BLs, high thrombus burden, and the RESOLVE-score showed better discrimination for SBO than the RESOLVE-score only (area under the curve [AUC] difference, 0.04; p=0.01). SBO showed significantly higher rates of in-hospital and 6-month MACE (log-rank p=0.001) and was among the independent predictors for follow-up MACE (hazard ratio, 3.27; 95% CI, 1.41-7.62; p=0.006).
Conclusions:
A predictive model comprising true BLs, high thrombus burden, and the RESOLVE-score showed better discrimination for SBO than the RESOLVE-score only.
