title: How bifurcation angle impacts the fate of side branch after main vessel stenting: a retrospective analysis of 1,200 consecutive bifurcation lesions in a single center.
abstract: OBJECTIVE
  We aimed to investigate the effect of bifurcation angle (BA) on side branch (SB) occlusion after main vessel (MV) stenting.
  
  
  BACKGROUND
  BA is thought to impact the risk of SB occlusion in coronary bifurcation patients undergoing percutaneous coronary intervention (PCI).
  
  
  METHODS
  A total of 1,171 consecutive patients with 1,200 bifurcation lesions undergoing one stent or provisional two stent techniques were studied. The lesions were divided into low angle and high angle groups using the median BA (52°). Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion.
  
  
  RESULTS
  SB occlusion occurred in 88 (7.33%) of 1,200 bifurcation lesions treated with the one stent technique or MV stenting first strategy. The rate of SB occlusion was significantly higher in the high angle group (63/600, 10.5%) than the low angle group (25/600, 4.2%) (P < 0.001). The rate of SB occlusion increased significantly across quartiles of BA as follows: from 3.63% in the first quartile of BA, to 4.71% in quartile II, to 8.14% in quartile III to 12.97% in quartile IV (P < 0.001). Multivariable analysis showed that high angle was an independent predictor of SB occlusion (odds ratio: 1.026, 95% confidence intervals: 1.014-1.037, P < 0.001). Plaque distribution at the same side of SB, MV Thrombolysis in Myocardial Infarction flow grade before stenting, pre-procedural diameter stenosis of bifurcation core, diameter ratio between MV/SB and diameter stenosis of SB before MV stenting were also independent predictors of SB occlusion.
  
  
  CONCLUSIONS
  High BA was an independent predictor of SB occlusion after MV stenting. The occlusion risk of SB with a high BA should not be ignored.
authors: State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, China.
authors: Dong
authors: D
authors: Zhang
authors: Bo
authors: B
authors: Xu
authors: Dong
authors: D
authors: Yin
authors: Yiping
authors: Y
authors: Li
authors: Yuan
authors: Y
authors: He
authors: Shijie
authors: S
authors: You
authors: Shubin
authors: S
authors: Qiao
authors: Yongjian
authors: Y
authors: Wu
authors: Hongbing
authors: H
authors: Yan
authors: Yuejin
authors: Y
authors: Yang
authors: Runlin
authors: R
authors: Gao
authors: Kefei
authors: K
authors: Dou
mesh_terms: D000368:Aged; D002681:China; D054059:Coronary Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000295:instrumentation* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
keywords: bifurcation angle; coronary bifurcation lesion; main branch; side branch occlusion; side vessel compromise