Real-world outcome of coronary bifurcation lesions in the drug-eluting stent era: results from the 4,314-patient Italian Society of Invasive Cardiology (SICI-GISE) Italian Multicenter Registry on Bifurcations (I-BIGIS).
BACKGROUND
Drug-eluting stents (DESs) introduction has somewhat renewed the issues of strategy and stenting technique for treatment of bifurcation lesions. In particular, concerns remain on extensive use of DESs, especially in the side branch, and on time of dual antiplatelet therapy (DAT) discontinuation, reflecting lack of pertinent long-term data. This study aimed to evaluate clinical safety and efficacy of different strategies for bifurcations treatment in a large observational real-world registry.


METHODS
A multicenter, retrospective Italian study of consecutive patients undergoing bifurcation percutaneous coronary intervention between January 2002 and December 2006 was performed. The primary end point was the long-term rate of major adverse cardiac events (MACEs). The role of DAT length on outcome was also analyzed.


RESULTS
A total of 4,314 patients (4,487 lesions) were enrolled at 22 independent centers. In-hospital procedural success rate was 98.7%. After median follow-up of 24 months, MACEs occurred in 17.7%, with cardiac death in 3.4%, myocardial infarction in 4.0%, target lesion revascularization in 13.2%, and stent thrombosis in 2.9%. Extensive multivariable analysis showed that MACEs were independently predicted by age, diabetes, renal failure, systolic dysfunction, multivessel disease, myocardial infarction at admission, restenotic lesion, bare-metal stent implantation, complex stenting strategy, and short duration of DAT.


CONCLUSIONS
This large study based on current clinical practice in an unselected patient population presenting with bifurcation disease and submitted to percutaneous coronary intervention demonstrated favorable long-term clinical results in this challenging patient setting, especially when DESs, simple stenting strategy, and DAT for at least 6 months are used.
Romagnoli
Enrico
E
San Raffaele Scientific Institute, Milan, Italy.
De Servi
Stefano
S
Tamburino
Corrado
C
Colombo
Antonio
A
Burzotta
Francesco
F
Presbitero
Patrizia
P
Bolognese
Leonardo
L
Paloscia
Leonardo
L
Rubino
Paolo
P
Sardella
Gennaro
G
Briguori
Carlo
C
Ettori
Federica
F
Franco
Gianfranco
G
Di Girolamo
Domenico
D
Sheiban
Imad
I
Piatti
Luigi
L
Greco
Cesare
C
Petronio
Sonia
S
Loi
Bruno
B
Lioy
Ernesto
E
Benassi
Alberto
A
Patti
Aldo
A
Gaspardone
Achille
A
Capodanno
Davide
D
Biondi-Zoccai
Giuseppe G L
GG
Sangiorgi
Giuseppe
G
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D003324:Coronary Artery Disease / Q000628:therapy; D023921:Coronary Stenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012042:Registries; D012107:Research Design; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome