title: Coronary bifurcation angle from 3-D predicts clinical outcomes after stenting bifurcation lesions.
abstract: BACKGROUND
  The predictive value of bifurcation angle (BA) for worse events after stenting bifurcation lesions remains to be unknown. The present study was to investigate the dynamic change of BA and clinical relevance for patients with coronary bifurcation lesions treated by drug-eluting stent (DES).
  
  
  METHODS
  BA was calculated by 3-D quantitative coronary analysis from 347 patients in DKCRUSH-II study. Primary endpoint was the occurrence of composite major adverse cardiac events (MACE) at 12-month, including cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR). Secondary end points were the rate of binary restenosis and stent thrombosis at 12-month.
  
  
  RESULTS
  Stenting was associated with the reduction of distal BA. The cut-off value of distal BA for predicting MACE was 60°. Distal BA in < 60° group had less reduction after stenting ((-1.96 ± 13.58)° vs. (-12.12 ± 23.58)°, P < 0.001); two-stent technique was associated with significant reduction of distal BA (Δ(-4.05 ± 14.20)°), compared to single stent group (Δ + 1.55 ± 11.73, P = 0.003); the target lesion revascularization (TLR), TVR and MACE rate was higher in one-stent group (16.5%, 19.0% and 21.5%), compared to two-stent group (3.8%, P = 0.002; 7.5%, P = 0.016; and 9.8%, P = 0.024), respectively. Among patients in ≥ 60° group, there were no significant differences in distal BA, stent thrombosis (ST), MI, MACE, death, TLR, TVR between one- and two-stent groups; after stenting procedure, there was only slight change of distal BA in left anterior descending (LAD)-left circumflex (LCX) subgroup (from (88.54 ± 21.33)° at baseline to (82.44 ± 31.72)° post-stenting), compared to either LAD-diagonal branch (Di), or LCX-obtuse marginal branch (OM), or RCA distal (RCAd) (all P < 0.001).
  
  
  CONCLUSIONS
  Two-stent technique was associated with significant reduction of distal BA. DK crush stenting had reduced rate of MACE in patients in < 60° group, compared to one-stent technique.
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, China. chmengx@126.com
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Teguh
authors.initials: T
authors.lastname: Santoso
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Xu
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.forename: Jing
authors.initials: J
authors.lastname: Kan
authors.forename: Chitprapai
authors.initials: C
authors.lastname: Paiboon
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhou
authors.forename: Shi-Qing
authors.initials: SQ
authors.lastname: Ding
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D055815:Young Adult