title: Impact of bifurcation lesions on angiographic characteristics and procedural success in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Bifurcation lesions (BFLs) remain a challenging lesion subset, often associated with lower success rates than less complex lesions. There are few data regarding the impact of BFLs in the setting of ST-segment elevation myocardial infarction (STEMI).
  
  
  OBJECTIVE
  To assess the impact of BFLs on angiographic characteristics and procedural success in primary percutaneous coronary interventions (PCIs).
  
  
  METHODS
  Out of 1070 primary PCIs performed between November 2006 and December 2008, 114 patients (10.7%) with a BFL (side branch ≥2.0mm) were identified and matched with 114 patients without a BFL, according to age, sex and infarct-related artery.
  
  
  RESULTS
  Baseline characteristics were similar in both groups. Using the Medina classification, true BFLs ([1,1,1]; [1,0,1]; [0,1,1]) were found in 46.5% of cases. Mean contrast volume (265±91 and 207±68mL), procedural time (51.0±26.6 vs 35.3±11.5min) and fluoroscopy time (16.2±11.2 vs 9.8±5.1min) were significantly higher in the BFL group than the non-BFL group (p<0.0001). However, time to reperfusion and angiographic success rates (residual stenosis ≤ 30% and Thrombolysis in Myocardial Infarction flow grade 3 in main branch) were similar in BFL and non-BFL patients (13.7±7.9 vs 12.1±5.7min, respectively, p=0.087; 96.5 vs 99.1%, respectively, p=0.18), with no periprocedural events (in-hospital death, emergent coronary artery bypass graft or repeat PCI<24h).
  
  
  CONCLUSIONS
  Despite being challenging lesions, BFLs in STEMI were associated with similar time to reperfusion and procedural success but led to significantly greater contrast use and prolonged procedural time compared with non-BFLs.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Interventional Cardiology Division, H1T1C8, Université de Montréal, Belanger Street East, Montreal, 5000 Quebec, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Frangos
authors.forename: Stéphane
authors.initials: S
authors.lastname: Noble
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
authors.forename: Anita
authors.initials: A
authors.lastname: Asgar
authors.forename: Annik
authors.initials: A
authors.lastname: Fortier
authors.forename: Quoc Hung
authors.initials: QH
authors.lastname: Ly
authors.forename: Raoul
authors.initials: R
authors.lastname: Bonan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003287:Contrast Media; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D011792:Quebec; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media