Evaluation of a strategy for treating bifurcated lesions by single or double stenting based on the Medina classification.
OBJECTIVE
The Medina bifurcated lesion classification has been widely adopted because of its simplicity. However, no data are available on its use in helping select the best stenting technique for bifurcations.


METHODS
Consecutive patients with bifurcated lesions (side branch >or=2.25 mm) were prospectively assessed using the Medina classification. The treatment strategy studied involved implanting two stents in lesions with a Medina classification of 1,1,1 (M3 group) and one stent in only the main vessel in lesions with other Medina classifications (OM group). Clinical endpoints were a major adverse cardiac event (MACE) and target lesion revascularization (TLR) during hospitalization and at 12-month follow-up.


RESULTS
The study included 120 patients: 25 in the M3 group and 95 in the OM group. There was no difference in baseline characteristics between the groups. The treatment strategy was successfully implemented in 97% of the OM group and 68% of the M3 group (P< .001). No death or TLR was recorded during hospitalization, though three myocardial infarctions occurred postoperatively (2.1% in the OM group vs 4.0% in the M3 group; P=.6). At 12 months, there was no difference in clinical outcome between the two groups (MACE: 12.6% in the OM group vs 8% in the M3 group; P=.4; TLR: 13.7% in the OM group vs 8% in the M3 group; P=.5). Multivariate analysis showed that bare metal stent implantation (only in patients receiving a single stent) was the only independent predictor of TLR.


CONCLUSIONS
The planned treatment strategy of implanting a single stent in patients with bifurcated lesions not classified as Medina 1,1,1 lesions was associated with a very low rate of second stent implantation. Moreover, bare metal stent use was a predictor of TLR, suggesting that drug-eluting stents should be used routinely to treat bifurcated lesions regardless of their angiographic complexity.
Todaro
Daniel
D
Instituto de Cardiología, Universidad Católica, Roma, Italia.
Burzotta
Francesco
F
Trani
Carlo
C
Brugaletta
Salvatore
S
De Vita
Maria
M
Talarico
Giovanni P
GP
Giammarinaro
Maura
M
Porto
Italo
I
Leone
Antonio Maria
AM
Niccoli
Giampaolo
G
Mongiardo
Rocco
R
Mazzari
Mario Attilio
MA
Schiavoni
Giovanni
G
Crea
Filippo
F
D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000145:classification / Q000175:diagnosis* / Q000601:surgery*; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D016896:Treatment Outcome