Impact of acute coronary syndrome classification and procedural technique on clinical outcomes in patients with coronary bifurcation lesions treated with drug-eluting stents.
BACKGROUND
We examined the impact of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) on clinical outcomes in patients with bifurcation lesions treated with drug-eluting stents.


OBJECTIVE
We hypothesized that NSTE-ACS would be attributable to the increased risk of major adverse cardiac events (MACE) in bifurcation percutaneous coronary intervention.


METHODS
We enrolled 1668 patients, using data from a multicenter real-world bifurcation registry. The primary objective was to compare the 2-year cumulative risk of MACE in patients with NSTE-ACS to those with stable angina. Major adverse cardiac events were defined as the composite endpoint of cardiac death, myocardial infarction (MI), and target-lesion revascularization.


RESULTS
Non-ST-segment elevation acute coronary syndrome was seen in 969 (58.1%) patients and stable angina in 699. Major adverse cardiac events occurred in 7.3% of NSTE-ACS patients and in 5.2% with stable angina (P = 0.042). However, cardiac death, MI, and target-lesion revascularization were similar between the 2 groups. We stratified patients with NSTE-ACS into those with non-ST-segment elevation MI and those with unstable angina. Cumulative risks of 2-year MACEs were 7.0% in non-ST-segment elevation MI patients and 7.5% in unstable angina patients (P = 0.87). In the NSTE-ACS cohort, the baseline lesion length in the side branch (adjusted hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01-1.07, P = 0.022), paclitaxel-eluting stents in the main vessel (adjusted HR: 2.02, 95% CI: 1.21-3.40, P = 0.008), and final kissing ballooning (adjusted HR: 1.88, 95% CI: 1.10-3.21, P = 0.021) were independent predictors of MACE.


CONCLUSIONS
Compared with stable angina patients, the NSTE-ACS patients who underwent bifurcation percutaneous coronary intervention had an increased risk of MACE during the 2-year follow-up.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.
Pil
P
Sang Song
Dong
D
Ryeol Ryu
Seung-Hyuk
SH
Choi
Jeong Hoon
JH
Yang
Young Bin
YB
Song
Joo-Yong
JY
Hahn
Jin-Ho
JH
Choi
Ki Bae
KB
Seung
Seung-Jung
SJ
Park
Hyeon-Cheol
HC
Gwon
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000787:Angina Pectoris / Q000188:drug therapy; D015906:Angioplasty, Balloon, Coronary; D016001:Confidence Intervals; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D013223:Statistics as Topic; D016896:Treatment Outcome
D007166:Immunosuppressive Agents