Does the target vessel impact on results of percutaneous coronary intervention for bifurcation Lesions? Insights from the I-BIGIS registry

Giuseppe Biondi-Zoccai, Imad Sheiban, Stefano De Servi, Corrado Tamburino, Giuseppe Sangiorgi, Enrico Romagnoli

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Bifurcations remain a challenging subset for percutaneous coronary intervention (PCI). Specifically, it is unclear whether bifurcations on left anterior descending (LAD) coronary arteries have the same prognosis of bifurcations on left circumflex (LCX) or right coronary arteries (RCA). We compared the results of PCI for bifurcation lesions, focusing on target vessel. Methods: Patients undergoing bifurcation PCI on the LAD were compared to those undergoing bifurcation PCI on the LCX and on the RCA. The primary endpoint was the long-term major adverse cardiac event (MACE) rate, defined as death, myocardial infarction, or target lesion revascularization (TLR). Results: A total of 2376 subjects were included, with 71.1% treated on the LAD, 21.5% on the LCX, and 7.4% on the RCA. Early MACE rates were similarly uncommon in the LAD (2.0%), RCA (2.3%), or LCX (1.2%) groups (P≤.46). Long-term outcomes (22.81 ± 2.7 months) were also similar, with MACE in 12.6%, 14.9%, and 12.4% (P≤.39), death in 4.0%, 4.5%, and 4.5% (P≤.83), myocardial infarction in 3.8%, 3.6%, and 3.0% (P≤.23), and stent thrombosis in 1.5%, 2.2%, and 1.7% (P≤.64), despite an apparent increase in TLR rates in the LCX group (12.4%) vs LAD (8.9%) or RCA (7.3%) groups (P≤.04). However, after multivariable adjustment, the risk of all long-term adverse events was similar irrespective of target vessel. Conclusions: Bifurcations localized in the LCX and RCA are associated with event rates at least as high as those in the LAD. Thus, care should be taken to skillfully perform PCI and maximize post-PCI medical therapy wherever the bifurcation lesion is located.

Original languageEnglish
Pages (from-to)660-665
Number of pages6
JournalJournal of Invasive Cardiology
Volume25
Issue number12
Publication statusPublished - 2013

Keywords

  • Bifurcation
  • coronary artery disease
  • percutaneous transluminal coronary angioplasty
  • stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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