Author + information
- Ignacio Sanchez-Perez1,
- Jesus Piqueras-Flores1,
- Alfonso Jurado-Román1,
- María Thiscal López Lluva1,
- Natalia Pinilla-Echeverri2,
- Ramón Maseda Uriza1 and
- Fernando Lozano1
The bifurcation segment is the most frequently affected in left main coronary artery (LMCA) disease. Classically, the treatment of this type of lesions have been the surgical revascularization. However, this paradigm is changing with the appearance of second-generation drug eluting stents (DES) with lower restenosis rates. The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) with DES on LMCA bifurcation at a 10-year follow-up.
We prospectively included 328 patients (69,3 ± 12,5 years, 74,4% male) with severe LMCA bifurcation disease undergoing PCI from June 2006 to April 2016. We evaluated major cardiovascular events defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (RLT) and stent thrombosis after long-term clinical follow-up (median 49 months).
53% of patients had stable coronary disease and 47% had acute coronary syndrome (9.5% with STEMI and 38.1% with NSTEMI). 40.5% of patients were diabetics and 35.1% had moderate-severe left ventricular systolic dysfunction. Mean logistic EuroSCORE mean was 5.78% and SYNTAX score was ≥ 23 in 36.6%. 68.8% of patients had LMCA and ≥ 2 associated coronary vessels disease. The most frequent bifurcation technique employed was “provisional stenting” (70.1%). “Crush stenting” was the second technique used in the 7.6%. Second generation DES was implanted in 89.6% and complication rate of procedure was 2.4%. During follow-up, MACE rate at 10 years was 17.9% (10.1% cardiac death, 1.8 nonfatal myocardial infarction, 4.6% TLR and 0.3% stent thrombosis). MACE rate was significantly higher in patients with chronic kidney disease, ventricular dysfunction and when final “kissing balloon” was not performed. TLR rate was significantly higher in patients treated with two stents technique (10.3% vs 3.8%, p=0.04) and with first generation DES (23.8% vs 3.8%, p=0.003).
Percutaneous treatment of LMCA bifurcation disease with DES has high effectiveness and safety with a low rate of complications and major cardiovascular events at long-term follow-up. Patients treated with two stents technique and first generation DES had more restenosis rate.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)