Long-term outcomes after stenting of bifurcation lesions with the "crush" technique: predictors of an adverse outcome.
OBJECTIVE
The purpose of this study was to evaluate predictors of an adverse outcome after "crush" bifurcation stenting.


BACKGROUND
The "crush" technique is a recently introduced strategy with limited data regarding long-term outcomes.


METHODS
We identified 231 consecutive patients treated with drug-eluting stent implantation with the "crush" technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%.


RESULTS
The in-hospital major adverse cardiac event (MACE) rate was 5.2%. At 9 months, 10 (4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization (TLR) was 90.3%; the only independent predictor of TLR was left main stem (LMS) therapy (odds ratio [OR] 4.97; 95% confidence interval [CI] 2.00 to 12.37, p = 0.001). Survival free of MACE was 83.5% and independent predictors of MACE were LMS therapy (OR 3.79; 95% CI 1.76 to 8.14, p = 0.001) and treatment of patients with multivessel disease (OR 4.21; 95% CI 0.95 to 18.56, p = 0.058). Angiographic follow-up was obtained in 77% of lesions at 8.3 +/- 3.7 months. The mean late loss of the main vessel and side branch were 0.30 +/- 0.64 mm and 0.41 +/- 0.67 mm, respectively, with binary restenosis rates of 9.1% and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss (0.24 +/- 0.50 mm vs. 0.58 +/- 0.77 mm, p < 0.001).


CONCLUSIONS
The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.
Hoye
Angela
A
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Iakovou
Ioannis
I
Ge
Lei
L
van Mieghem
Carlos A G
CA
Ong
Andrew T L
AT
Cosgrave
John
J
Sangiorgi
Giuseppe M
GM
Airoldi
Flavio
F
Montorfano
Matteo
M
Michev
Iassen
I
Chieffo
Alaide
A
Carlino
Mauro
M
Corvaja
Nicola
N
Aoki
Jiro
J
Rodriguez Granillo
Gaston A
GA
Valgimigli
Marco
M
Sianos
Georgios
G
van der Giessen
Willem J
WJ
de Feyter
Pim J
PJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
Colombo
Antonio
A
D000787:Angina Pectoris / Q000209:etiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000150:complications / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D011183:Postoperative Complications; D011379:Prognosis; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D003692:Delayed-Action Preparations; D017239:Paclitaxel; D020123:Sirolimus