title: Prospective evaluation of myocardial ischemia related to post-procedural side-branch stenosis in bifurcated lesions treated by provisional approach with drug-eluting stents.
abstract: OBJECTIVE
  To prospectively assess the impact of post-procedural side-branch (SB) stenosis on inducible myocardial ischemia in patients with bifurcated lesions undergoing percutaneous interventions.
  
  
  BACKGROUND
  Provisional-stenting with drug-eluting stents (DES) is the recommended strategy to treat percutaneously bifurcated lesions but is associated to variable degrees of residual SB stenosis. The role of SB residual stenosis on post-procedural myocardial ischemia is uncertain.
  
  
  METHODS
  Patients with bifurcations treated by DES according to provisional-stenting technique were enrolled in the study if they had no other untreated lesion. Patients were divided into two groups according to post-procedural 3D-quantitative coronary analysis (3DQCA): group OR (optimal result: stenosis < 50% of SB lumen area at 3DQCA) and group SR, suboptimal result: (stenosis ≥ 50% of SB lumen area at 3DQCA). Treadmill exercise stress test (EST) was performed within 1 week from PCI. The primary study endpoint was myocardial ischemia (≥1 mm ST-segment depression at EST).
  
  
  RESULTS
  Sixty patients were enrolled: 49 (81.7%) comprised group OR and 11 (18.3%) group SR. Post-PCI myocardial ischemia at EST was inducible in 17 (34.7%) patients of group OR versus 10 (90.9%) patients of group SR (P = 0.0007). During the follow-up, patients of Group SR (vs. Group OR) had a significantly higher occurrence of inducible myocardial ischemia during late (>8 weeks) stress tests (P < 0.001).
  
  
  CONCLUSIONS
  In patients with bifurcated lesions treated by a provisional-stenting technique, residual SB stenosis ≥ 50% at 3DQCA is associated with post-procedural inducible myocardial ischemia at EST.
authors: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. f.burzotta@rm.unicatt.it
authors: Francesco
authors: F
authors: Burzotta
authors: Carlo
authors: C
authors: Trani
authors: Daniel
authors: D
authors: Todaro
authors: Gaetano Antonio
authors: GA
authors: Lanza
authors: Luca
authors: L
authors: Mariani
authors: Antonella
authors: A
authors: Tommasino
authors: Giampaolo
authors: G
authors: Niccoli
authors: Italo
authors: I
authors: Porto
authors: Antonio Maria
authors: AM
authors: Leone
authors: Filippo
authors: F
authors: Crea
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation*; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D054855:Drug-Eluting Stents; D005080:Exercise Test; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D012384:Rome; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome