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Several studies had revealed that three dimensional (3D) quantitative coronary angiography (QCA) overcomes the shortcoming of 2–dimensional QCA regarding bifurcation angle analysis. The impact of bifurcation angle (BA) in left main (LM) on clinical outcomes after single stenting treated with drug–eluting stent (DES) have never been documented. The Aim of this study was to investigate the impact of unprotected LM bifurcation angle on clinical outcomes after cross over single stent strategy using DES with 3D QCA.
A total of 152 patients who underwent PCI in unprotected LM bifurcation with successful single cross over DES stenting from the LM into the left anterior descending artery (LAD) were enrolled. The proximal bifurcation angle (between LM and LAD), the distal bifurcation angle (between LAD and left circumflex [LCX]), and the reverse bifurcation angle (between LM and LCX) were computed in end–diastole before PCI with 3D QCA software. The cumulative incidence of major adverse cardiac event (MACE: cardiac death, myocardial infarction and any target lesion revascularization) rates and predictors of MACE throughout the 12–month were analyzed.
Mean follow up duration was 353 ± 51.3 days. Free survival rate from MACE was 89.5% (136 cases). All BA parameters and final kissing balloon technique were variables associated with a high risk of MACE by univariate analysis. However, in multivariate analysis, only pre–PCI distal BA and proximal BA were significant independent predictors of MACE (Hazard ratio: 0.96; 95% confidence interval: 0.94 to 0.96, P=0.0081, Hazard ratio: 0.98; 95% confidence interval: 0.96 to 1.00, P=0.036).
Pre–PCI distal bifurcation angle and proximal bifurcation angle were independent predictors of MACE after single stent strategy cross over LM to LAD using DES.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Left Main and Bifurcation Intervention
Abstract Category: 46. TCT@ACC–i2: Coronary Intervention, LM/Bifurcations
Presentation Number: 2105–246
- 2013 American College of Cardiology Foundation