Author + information
- Soledad Ojeda1,
- Lorenzo Azzalini2,
- Jorge Chavarria Viquez1,
- Antonio Serra3,
- Francisco Hidalgo4,
- Susanna Benincasa5,
- Livia L. Gheorghe3,
- Roberto Diletti6,
- Miguel Romero1,
- Barbara Bellini5,
- Alejandro Gutierrez-Barrios7,
- Javier Suarez De Lezo4,
- José Segura1,
- Mauro Carlino5,
- Antonio Colombo8 and
- Manuel Pan1
- 1Reina Sofia Hospital, Córdoba, Spain
- 2Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Milan, Italy
- 3Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- 4Reina Sofia Hospital, Cordoba, Spain
- 5San Raffaele Scientific Institute, Milan, Milan, Italy
- 6Thorax Center, Erasmus MC, Rotterdam, Netherlands
- 7Hospital Puerta del Mar, Cádiz, Spain
- 8San Raffaele Scientific Institute, Milan, Italy
Little evidence exists regarding the optimal strategy for bifurcation lesions (BLs) in the context of a coronary chronic total occlusion (CTO). Our study aim was to compare the procedural and mid-term outcomes of patients with BLs in CTO treated with provisional stenting (simple approach) versus 2-stent techniques (complex strategy) in a multicenter registry.
Between January 2012 and June 2016, 922 CTO in 905 patients were successfully recanalized at the 4 participating centers. Of those, 238 patients with 238 CTO (25.8%) and a BL (Side branch ≥2mm located proximally, distally or within the occluded segment) were treated by a simple approach (n=201) o complex strategy (n=37). Propensity score matching (PSM) was performed to account for selection bias between both groups and 37 matched pairs were generated. Standardized differences were calculated for all covariates before and after matching to assess balance after matching (Figure). Technical success of CTO recanalization was defined as a residual stenosis <30% with TIMI flow grade III in the main vessel. Bifurcation technical success was considered to occur when a residual stenosis of <30% in the main vessel and a final TIMI flow grade III in both branches were obtained. Procedural success was defined as angiographic success plus the absence of in-hospital adverse events. Major adverse cardiac events (MACE) on follow-up were a composite of cardiac death, myocardial infarction, and clinical-driven target lesion revascularization.
Angiographic and procedural success were comparable in the simple vs. complex group (94.5% vs 97.3%, p=0.48; and 85.6% vs 81.1%, p=0.49). In all cases, bifurcation technical failure was due to a TIMI flow at the side branch <III. However, contrast volume, radiation dose and fluoroscopy time were lower in the simple approach. At follow-up (median of 25 months), MACE rate was 8% in the simple and 10.8% in the complex group (p=0.58). There was a trend towards a lower MACE-free survival in the complex group (80.1% vs 69.8%, p=0.08). After PSM, there were no differences between groups with regard to immediate and follow-up results, although a complex strategy was associated with worse procedural metrics (Contrast volume (ml): 367±111 vs 301±103, p< 0.01; radiation (Gy/cm2): 452.8±208.1 vs 354.1±303.7, p= 0.04; fluoroscopy time (min): 61.2±27.7 vs 47.7±28.9, p= 0.04).
BLs in CTO can be approached as is done for regular BLs, for which provisional stenting is considered the technique of choice. After PSM, there were no differences in procedural and mid-term clinical outcomes between simple and complex strategies.
CORONARY: PCI Outcomes