The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II).
OBJECTIVE
Little is known about the impact of treating bifurcations on the overall outcome of multivessel coronary artery disease treated with stenting. This analysis was made to investigate the 1 year clinical outcome of the treatment of bifurcation lesions using sirolimus-eluting stents (SES) in patients with multivessel disease.


RESULTS
Among a total of 607 patients (2160 lesions) in the Arterial Revascularization Therapies Study part II (ARTS II), there were 324 patients in whom at least one bifurcation lesion was treated (465 lesions). Patients with bifurcations were compared with those without bifurcations in terms of baseline characteristics and major adverse cardiac and cerebrovascular events (MACCE). Patients with 'true' (200 patients) vs. 'partial' bifurcations (124 patients) and usage of a one- (263 patients) vs. two-stent strategy (61 patients) were also evaluated. The bifurcation group was associated with more complex lesion and procedural characteristics than the non-bifurcation group. However, there was no significant difference in 1 year MACCE rates between the bifurcation group and the non-bifurcation group (13.3 vs. 11.0%, P=0.46). MACCE in patients with true bifurcations was 13.0 vs. 13.7% for partial bifurcations (P=0.87) and 14.1 vs. 9.8% for one- vs. two-stent strategy (P=0.53).


CONCLUSIONS
In this trial without angiographic follow-up, the presence of bifurcations did not affect 1 year outcomes after SES implantation. The outcomes in true vs. partial bifurcations and using one vs. two stents were similar when the treatment strategies were left to the operator's discretion.
Tsuchida
Keiichi
K
Thoraxcenter, Ba 583, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Colombo
Antonio
A
Lefèvre
Thierry
T
Oldroyd
Keith G
KG
Guetta
Victor
V
Guagliumi
Giulio
G
von Scheidt
Wolfgang
W
Ruzyllo
Witold
W
Hamm
Christian W
CW
Bressers
Marco
M
Stoll
Hans-Peter
HP
Wittebols
Kristel
K
Donohoe
Dennis J
DJ
Serruys
Patrick W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D023921:Coronary Stenosis / Q000628:therapy*; D004343:Drug Implants; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control; D009204:Myocardial Revascularization / Q000379:methods*; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D016896:Treatment Outcome
D004343:Drug Implants; D007166:Immunosuppressive Agents; D020123:Sirolimus