An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study

An Upfront Two-Stent Strategy for True Coronary Bifurcation Lesions with A Large Side Branch in Acute Coronary Syndrome: A Two-Year Follow-Up Study

Blog Article

Background and Objectives: Little is known about the upfront two-stent strategy (U2SS) for true coronary bifurcation lesions (CBLs) in acute coronary syndrome (ACS).We aimed to present our two-year follow-up results on the U2SS by using different two-stent techniques for the true CBL with a large side branch (SB) in ACS patients, including unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), and to identify independent predictors of the presence of major adverse cardiac events (MACEs) after intervention.Materials and Methods: The study included 201 consecutive ACS patients with true CBLs who underwent percutaneous coronary intervention (PCI) using U2SS from October 2015 to March 2018.Clinical outcomes at follow-up were assessed.

MACE was defined as a composite of cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR).Results: 31.3% of the patients had an UA, 46.3% had an NSTEMI, and 22.

4% had an STEMI.CBL was most frequently located in the left anterior descending (LAD)/diagonal artery (59.2%).In total, Baby Food 71.

1% of the patients had a Medina classification (1,1,1).Overall, 62.2% of cases were treated with mini-crush stenting.Clopidogrel was given in 23.

9% of the patients; 71.1% of the patients received everolimus eluting stent (EES); and 11.9% received a sirolimus eluting stent (SES).Final kissing balloon inflation was carried out in all patients, with an unsatisfactory rate of 5%.

A proximal optimization technique sequence was successfully carried out in all patients.The MACE incidence was 16.9% with a median follow-up period of 2.1 years.

There were seven cardiac deaths (3.5%).The TLR rate was 13.4% (n = 27), with PCI treatment in 16 patients, and coronary artery bypass grafting treatment in 11 patients.

After multivariate penalized R/C Car logistic regression analysis (Firth logistic regression), clopidogrel use (odds ratio (OR): 2.19; 95% confidence interval (CI): 0.41−2.51; p = 0.

007) and SES use (OR: 1.86; 95% CI: 0.31−2.64; p = 0.

014) were independent predictors of the presence of MACE.Conclusion: U2SS is feasible and safe for the true CBLs with large and diseased SB in ACS patients, and is related to a relatively low incidence of MACE.Clopidogrel use and SES use may predict the MACE development in ACS patients treated using U2SS.