Mid-term outcomes after percutaneous interventions in coronary bifurcations.

Aged Coronary Angiography Coronary Artery Disease / diagnosis Coronary Vessels / diagnostic imaging Drug-Eluting Stents Europe / epidemiology Female Follow-Up Studies Humans Incidence Middle Aged Percutaneous Coronary Intervention / methods Postoperative Complications / epidemiology Registries Retrospective Studies Risk Assessment / methods Risk Factors Survival Rate / trends Time Factors Treatment Outcome

Coronary bifurcation Drug-eluting stent Outcome Percutaneous coronary intervention

Journal

International journal of cardiology

ISSN: 1874-1754

Titre abrégé: Int J Cardiol

Pays: Netherlands

ID NLM: 8200291

Informations de publication

Date de publication:
15 05 2019

Historique:

received: 10 08 2018

revised: 07 10 2018

accepted: 30 11 2018

pubmed: 12 12 2018

medline: 24 12 2019

entrez: 12 12 2018

Statut: ppublish

Résumé

The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated. Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected. Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%). At multivariable Cox regression, left ventricular ejection fraction ≤30% (P < 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P < 0.001), admission for an acute coronary syndrome (P < 0.001), age >66 years (P < 0.001), multivessel disease (P < 0.001) and diabetes (P < 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P < 0.001) and side branch (SB) lesion length ≥9 mm (P < 0.05) as additional independent predictors of MACE. Beyond traditional risk factors, multivessel disease, the length of the SB lesion, "bail-out" stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations. This highlights the importance of a carefully planned PCI strategy and adequate therapy adherence to improve the clinical outcomes in these patients. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01967615.

Sections du résumé

BACKGROUND

The optimal treatment of patients undergoing percutaneous coronary interventions (PCI) for lesions located at coronary bifurcations is still debated.

METHODS

Data on 5036 consecutive patients who underwent PCI on coronary bifurcation at 17 major coronary intervention centers between January 2012 and December 2014 were collected.

RESULTS

Follow-up at a median 18 months (IQR 11-28) was available for 4506 patients (89%). Major Adverse Cardiac Events (MACE) occurred in 395 patients (8.8%): cardiac death in 152 (3.4%), myocardial infarction, excluding periprocedural, in 156 (3.5%) and stent thrombosis in 110 cases (2.4%). At multivariable Cox regression, left ventricular ejection fraction ≤30% (P < 0.001), bail-out stenting (beyond a planned strategy of either single or double stenting) (P < 0.001), admission for an acute coronary syndrome (P < 0.001), age >66 years (P < 0.001), multivessel disease (P < 0.001) and diabetes (P < 0.001) were independently associated with MACE. Sensitivity analysis identified premature discontinuation of dual antiplatelet therapy (DAPT) (P < 0.001) and side branch (SB) lesion length ≥9 mm (P < 0.05) as additional independent predictors of MACE.

CONCLUSIONS

Beyond traditional risk factors, multivessel disease, the length of the SB lesion, "bail-out" stenting and premature DAPT discontinuation are independent predictors of mid-term MACE after PCI of coronary bifurcations. This highlights the importance of a carefully planned PCI strategy and adequate therapy adherence to improve the clinical outcomes in these patients.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01967615.

Identifiants

DOI: 10.1016/j.ijcard.2018.11.139 PMID: 30528620

pubmed: 30528620

pii: S0167-5273(18)34855-1

doi: 10.1016/j.ijcard.2018.11.139

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT01967615']

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

78-83