Influence of technical strategies on the outcome of coronary bifurcation stenting.
OBJECTIVE
The purpose of this study was to analyze from a large prospective database started in 1996, the immediate and mid term results of coronary bifurcation stenting using bare metal stents.


BACKGROUND
Stenting of bifurcation lesions remains a challenging subset. Various approaches have been advocated and no large prospective studies are available on this subject.


METHODS
Between 1996 and 2002, data were prospectively collected on all patients with bifurcation lesions treated with coronary stenting in our institution. Seven-month follow-up data were obtained in 96.7% of patients and coronary angiogram was performed in the presence of clinical or stress test ischemia. The database was analyzed to extract uni-variate and multivariate predictors of acute and 7 months adverse events.


RESULTS
A total of 1,149 patients were included, median age 65 years, 19% diabetic patients, unstable angina in 37.3% of cases and acute MI 10.5%. The target was the LAD-diagonal bifurcation in 53.2% of cases. Angiographic success (residual stenosis < 30%) was obtained in 96.3% of cases for the main branch (MB) and side branch (SB) 92.9 % (residual stenosis < 50%). The in-hospital MACE rate was 4.6 %. At seven months follow-up, a total MACE rate of 18.1% was observed including a target vessel revascularization rate of 13.2% and death rate of 1.6%. By multivariate analysis, independent predictors of MACE at seven month follow-up were unstable angina (OR 5.02 , p = 0.001, 95 % CI : 3.5 - 7.2), type 4 lesion (OR 3.31, p = 0.005, 95 % CI : 1.4 - 7.7), a MB < 2.7 mm (OR 1.8, p = 0.024, 95 % CI : 1.08 - 3.01), non use of a provisional T stenting strategy for the SB (OR 0.48, p = 0.006, 95 % CI : 0.40 - 0.86), and SB stenting (OR 1.48, p = 0.035, 95 % CI : 1.32 - 2.14).


CONCLUSIONS
Provisional T stenting strategy applied to the SB is a predictor of favourable outcome after coronary bifurcation stenting using bare metal stents. It significantly reduces the rate of MACE as well as the need for repeat TVR at 7-month follow-up.
Lefèvre
Thierry
T
Institut Cardiovasculaire Paris Sud, Massy, France.
Morice
Marie-Claude
MC
Sengottuvel
Gunasekaran
G
Kokis
André
A
Monchi
Mehran
M
Dumas
Pierre
P
Garot
Philippe
P
Louvard
Yves
Y