title: Long-term outcomes after stenting of bifurcation lesions with the "crush" technique: predictors of an adverse outcome.
abstract: 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.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Lei
authors.initials: L
authors.lastname: Ge
authors.forename: Carlos A G
authors.initials: CA
authors.lastname: van Mieghem
authors.forename: Andrew T L
authors.initials: AT
authors.lastname: Ong
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Giuseppe M
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Nicola
authors.initials: N
authors.lastname: Corvaja
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Gaston A
authors.initials: GA
authors.lastname: Rodriguez Granillo
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.forename: Willem J
authors.initials: WJ
authors.lastname: van der Giessen
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: 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
chemical_list: D002317:Cardiovascular Agents; D003692:Delayed-Action Preparations; D017239:Paclitaxel; D020123:Sirolimus