title: Predictors of long-term outcome after crush stenting of coronary bifurcation lesions: importance of the bifurcation angle.
abstract: OBJECTIVE
  We hypothesized that the bifurcation angle (BA) may affect the outcome of crush stenting (CS) of bifurcation lesions and thus set out to determine the effect of the BA on outcome of patients undergoing coronary bifurcation CS.
  
  
  METHODS
  Of 538 bifurcation PCI cases performed between November 2003 and March 2005, 133 were performed using CS (n = 56), balloon CS (n = 71), or reverse CS (n = 6). Patients were divided into low-angle and high-angle groups using the median BA as the cut point.
  
  
  RESULTS
  The median BA was 50 degrees. High-angle patients were more likely to be women (33% vs 15%, P = .02), with a prior percutaneous coronary intervention (26% vs 12%. P = .05) and coronary artery bypass grafting (15% vs 5%, P = .05). Procedural success was 98.5% in the low-angle and 95.4% in the high-angle group (P = nonsignificant). Two high-angle patients had acute stent thrombosis, and 1 died in hospital. Four additional high-angle patients (6.1%) and 1 low-angle patient (1.5%) died (P = nonsignificant) during follow-up. Major adverse cardiac events (MACE) occurred more frequently in the high-angle group (22.7% vs 6.2%, P = .007). Bifurcation angle > or = 50 degrees (P = .004), no final kissing balloon inflation (P = .012), and creatinine clearance < 40 mL/min (P = .031) independently predicted MACE.
  
  
  CONCLUSIONS
  Bifurcation angle > or = 50 degrees is an independent predictor of MACE after bifurcation CS, in addition to no final kissing balloon inflation and severe renal dysfunction. A high BA confers a setting of increased turbulent flow that is further exacerbated by suboptimal treatment of the crushed side-branch stent. Further study to improve outcome in this subset of patients is warranted.
authors.affiliation: Interventional Cardiology Program, Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada. vlad.dzavik@uhn.on.ca
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kharbanda
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Ing
authors.forename: Sanh
authors.initials: S
authors.lastname: Bui
authors.forename: Karen
authors.initials: K
authors.lastname: Mackie
authors.forename: Rachael
authors.initials: R
authors.lastname: Ramsamujh
authors.forename: Alan
authors.initials: A
authors.lastname: Barolet
authors.forename: Leonard
authors.initials: L
authors.lastname: Schwartz
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome