Author + information
- Ali Elfandi1
Coronary bifurcation lesions are a complex subset of lesions commonly encountered in the cardiac catheterization laboratory. Trans-radial (TR) percutaneous coronary intervention (PCI) has not replaced the trans-femoral (TF) PCI as the preferred approach for coronary PCI despite comparable outcomes and lower complication rates seen with TR PCI cases across multiple large randomized studies. Furthermore, there is often equipoise among experienced operators between the two approaches when dealing with complex bifurcation lesions. Therefore, we sought to compare the procedural outcomes of TR vs TF PCI in consecutive patients referred to our institution in 2015 who underwent PCI of a true bifurcation lesion.
The CathPCI registry of all patients referred to our institution and underwent a bifurcation PCI in 2015 were included for review. Charts and cardiac catheterization images were reviewed. Medina type (1.1.1), (1.0.1), and (0.1.1) lesions with a side branch (SB) of 2mm in diameter or greater were defined as true bifurcation lesions. Angiographic success was defined as the achievement of a Thrombolysis in Myocardial Infarction (TIMI) flow grade of 3 with a final residual stenosis of < 30% for the main vessel (MV) or < 50% for the SB by visual estimation. The bifurcation PCIs that met the above criteria were included in the statistical analysis.
A total of 5140 patients underwent cardiac catheterization at our institution in 2015 and 2438 (47%) patients had a PCI. Of the 229 patients who underwent bifurcation PCIs — 135 (59%) patients met the inclusion criteria and were included in the statistical analysis. The mean age was 69.9 ± 17 years, 79% were male and 94% were Caucasian. Ninety-seven (72%) patients had TF bifurcation PCI and 38 (28%) had TR bifurcation PCI. Of the 97 TF bifurcation PCIs 89 (92%) were successful and of the 38 TR PCIs 36 (95%) were successful PCIs (p= 0.98) by our angiographic criteria.
Compared to the TF approach, TR bifurcation PCI is feasible and results in similar procedural outcomes. Based on the results of our current study, we conclude that TR bifurcation PCI achieves similar angiographic success rates when compared to the traditional TF approach. To our knowledge this is the first US study to compare TR and TF approach in bifurcation PCIs.
CORONARY: Angioplasty Overview and Outcomes