title: Bifurcation lesions involved in the recanalization process of coronary chronic total occlusions: Incidence, treatment and clinical implications.
abstract: BACKGROUND
  The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact.
  
  
  RESULTS
  BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was <III. Predictors of bifurcation success were baseline SB wiring (OR 0.01, 95% CI: 0.001-0.09; p<0.01), the absence of dissection across the bifurcation (OR 0.10, 95% CI: 0.02-0.49; p<0.01) and non-true BLs (OR 0.16, 95% CI: 0.04-0.68; p<0.05). Regarding in-hospital results, patients with final TIMI flow <III at the SB had a higher incidence of periprocedural MI (32% vs 4.8%; p<0.01). Subsequently, the rate of MI was higher in patients with CTO-BLs than in those without BLs. At follow-up, there were no differences in the event rate between CTO-BLs and non CTO-BLs (7.7% vs 9.5%, p=ns) CONCLUSIONS: BLs in CTO is a frequent finding and could be approached as regular bifurcations. The primary success was low and this was associated with a higher incidence of periprocedural MI. Baseline SB wiring was a powerful predictor of technical success.
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain. Electronic address: soledad.ojeda18@gmail.com.
authors.forename: Soledad
authors.initials: S
authors.lastname: Ojeda
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.affiliation: Jerez Hospital, Department of Cardiology, Jerez de la Frontera, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Romero
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Chavarría
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Javier Suárez
authors.initials: JS
authors.lastname: de Lezo
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mazuelos
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Pardo
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Hidalgo
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Carrasco
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: José
authors.initials: J
authors.lastname: Segura
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Durán
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferreiro
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: José J
authors.initials: JJ
authors.lastname: Sánchez
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Jerez Hospital, Department of Cardiology, Jerez de la Frontera, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Oneto
authors.affiliation: Reina Sofia Hospital, Department of Cardiology, University of Córdoba, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Spain.
authors.forename: Jose Suárez
authors.initials: JS
authors.lastname: de Lezo
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D015607:Stents; D016896:Treatment Outcome
keywords: Bifurcation intervention; Chronic total coronary occlusion; Drug-eluting stent; Percutaneous coronary intervention