Side branch occlusion after main vessel stenting was associated with an increased risk of cardiac death or myocardial infarction (adjusted HR 2.34; 95% CI 1.15-4.77; p=0.02).
Cohort (n=2,227)
What are the predictors of side branch occlusion after main vessel stenting in coronary bifurcation lesions, and does it increase the risk of cardiac death or myocardial infarction?
Side branch occlusion after main vessel stenting in bifurcation lesions is predicted by baseline stenosis severity and acute coronary syndrome presentation, and is associated with an increased risk of cardiac death or myocardial infarction.
Effect estimate: adjusted HR 2.34 (95% CI 1.15 to 4.77)
p-value: p=0.02
OBJECTIVES: This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. BACKGROUND: SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. METHODS: Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB ≥2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade <3. RESULTS: SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB ≥50% (odds ratio OR: 2.34; 95% confidence interval CI: 1.59 to 3.43; p < 0.001) and the proximal MV ≥50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). CONCLUSIONS: Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes..
Hahn et al. (Wed,) conducted a cohort in Coronary bifurcation lesions (n=2,227). Side branch occlusion vs. No side branch occlusion was evaluated on Cardiac death or myocardial infarction (adjusted HR 2.34, 95% CI 1.15 to 4.77, p=0.02). Side branch occlusion after main vessel stenting was associated with an increased risk of cardiac death or myocardial infarction (adjusted HR 2.34; 95% CI 1.15-4.77; p=0.02).