Mid-term outcomes after percutaneous interventions in coronary bifurcations.

Autor: Zimarino M; Institute of Cardiology 'G. d'Annunzio' University, Chieti, Italy; Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy. Electronic address: m.zimarino@unich.it., Briguori C; Interventional Cardiology Unit, Clinica Mediterranea, Naples, Italy., Amat-Santos IJ; CIBERCV, Hospital Clínico Universitario de Valladolid, Spain., Radico F; Institute of Cardiology 'G. d'Annunzio' University, Chieti, Italy., Barbato E; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy., Chieffo A; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy., Cirillo P; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy., Costa RA; Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil., Erglis A; Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, Riga, Latvia., Gamra H; Cardiology Department, Fattouma Bourguiba Hospital, University of Monastir, Tunisia., Gil RJ; Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland., Kanic V; Department of Cardiology and Angiology, University Medical Centre, Maribor, Slovenia., Kedev SA; University Clinic of Cardiology Skopje, Skopje, Macedonia., Maddestra N; Interventional Cath Lab, ASL 2 Abruzzo, Chieti, Italy., Nakamura S; Department of Cardiology, New Tokyo Hospital, Chiba, Japan., Pellicano M; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy; Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy., Petrov I; City Clinic, Sofia, Bulgaria., Strozzi M; Department of Cardiovascular Medicine, University Hospital Centre, Zagreb, Croatia., Tesorio T; Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy., Vukcevic V; Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Serbia., De Caterina R; Institute of Cardiology 'G. d'Annunzio' University, Chieti, Italy., Stankovic G; Department of Cardiology, Clinical Center of Serbia, University of Belgrade, Serbia.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2019 May 15; Vol. 283, pp. 78-83. Date of Electronic Publication: 2018 Dec 02.
DOI: 10.1016/j.ijcard.2018.11.139
Abstrakt: 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.
(Copyright © 2018 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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