title: Long-term outcomes using a two-stent technique for the treatment of coronary bifurcations.
abstract: BACKGROUND
  The crush and culotte are probably the most common two-stent techniques utilized for percutaneous coronary intervention (PCI) of complex bifurcation lesions. Long-term outcome associated with the utilization of these techniques is unknown. Our objective was to evaluate the long-term outcomes after bifurcation PCI utilizing these 2 techniques with a prospective PCI registry.
  
  
  METHODS
  Between 11/1/2003 and 12/31/2007, 360 patients were treated with either crush (n=304) or culotte (n=56). Primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction and target vessel revascularization. The major secondary outcome measure was MACE or occurrence of CCS Class ≥ 2 angina.
  
  
  RESULTS
  After a median follow-up of 4.1 years (3.0-5.1), the occurrence of MACE was 23.9%. MACE or CCS Class ≥ 2 angina occurred in 27.5% of patients. Multivariable analysis revealed that creatinine clearance <60 ml/min (odds-ratio [OR]=1.71, 95% CI 1.08-2.71; p=0.022) and left ventricular ejection fraction <40% (OR=2.14, 95% CI 1.21-3.79; p=0.008) were independent predictors of MACE or CCS Class ≥ 2 angina. A larger main vessel reference diameter (OR=0.57, 95% CI 0.61-0.92), bifurcation angle <50% (OR=0.59, 95% CI 0.35-0.92) and a final kissing-balloon inflation (OR=0.75, 95% CI 0.35-0.99) were associated with a lower risk of MACE or CCS Class ≥ 2 angina.
  
  
  CONCLUSIONS
  Application of the crush and culotte techniques is associated with efficacy and safety at long-term follow-up. Bifurcation angle, a final kissing balloon inflation and vessel reference diameter are important variables that impact on very long-term outcomes.
authors.affiliation: Peter Munk Cardiac Centre, University Health Network, Interventional Cardiology Program, Division of Cardiology, Toronto, Ontario, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Ali A
authors.initials: AA
authors.lastname: Almasood
authors.forename: Nadia
authors.initials: N
authors.lastname: Asif
authors.forename: Sanh
authors.initials: S
authors.lastname: Bui
authors.forename: Joan
authors.initials: J
authors.lastname: Ivanov
authors.forename: Mark D
authors.initials: MD
authors.lastname: Osten
authors.forename: Douglas
authors.initials: D
authors.lastname: Ing
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Overgaard
authors.forename: Eric
authors.initials: E
authors.lastname: Horlick
authors.forename: Peter H
authors.initials: PH
authors.lastname: Seidelin
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bifurcations; Crush; Culotte; Provisional stenting