Prospective evaluation of myocardial ischemia related to post-procedural side-branch stenosis in bifurcated lesions treated by provisional approach with drug-eluting stents

Francesco Burzotta, Carlo Trani, Daniel Todaro, Gaetano Antonio Lanza, Luca Mariani, Antonella Tommasino, Giampaolo Niccoli, Italo Porto, Antonio Maria Leone, Filippo Crea

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives: To prospectively assess the impact of post-procedural side-branch (SB) stenosis on inducible myocardial ischemia in patients with bifurcated lesions undergoing percutaneous interventions. Background: Provisional-stenting with drug-eluting stents (DES) is the recommended strategy to treat percutaneously bifurcated lesions but is associated to variable degrees of residual SB stenosis. The role of SB residual stenosis on post-procedural myocardial ischemia is uncertain. Methods: Patients with bifurcations treated by DES according to provisional-stenting technique were enrolled in the study if they had no other untreated lesion. Patients were divided into two groups according to post-procedural 3D-quantitative coronary analysis (3DQCA): group OR (optimal result: stenosis <50% of SB lumen area at 3DQCA) and group SR, suboptimal result: (stenosis ≥ 50% of SB lumen area at 3DQCA). Treadmill exercise stress test (EST) was performed within 1 week from PCI. The primary study endpoint was myocardial ischemia (≥1 mm ST-segment depression at EST). Results: Sixty patients were enrolled: 49 (81.7%) comprised group OR and 11 (18.3%) group SR. Post-PCI myocardial ischemia at EST was inducible in 17 (34.7%) patients of group OR versus 10 (90.9%) patients of group SR (P = 0.0007). During the follow-up, patients of Group SR (vs. Group OR) had a significantly higher occurrence of inducible myocardial ischemia during late (>8 weeks) stress tests (P <0.001). Conclusions: In patients with bifurcated lesions treated by a provisional-stenting technique, residual SB stenosis ≥ 50% at 3DQCA is associated with post-procedural inducible myocardial ischemia at EST.

Original languageEnglish
Pages (from-to)351-359
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume79
Issue number3
DOIs
Publication statusPublished - Feb 15 2012

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Drug-Eluting Stents
Myocardial Ischemia
Pathologic Constriction
Exercise Test

Keywords

  • coronary flow
  • percutaneous coronary intervention
  • quantitative vascular angiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Prospective evaluation of myocardial ischemia related to post-procedural side-branch stenosis in bifurcated lesions treated by provisional approach with drug-eluting stents. / Burzotta, Francesco; Trani, Carlo; Todaro, Daniel; Lanza, Gaetano Antonio; Mariani, Luca; Tommasino, Antonella; Niccoli, Giampaolo; Porto, Italo; Leone, Antonio Maria; Crea, Filippo.

In: Catheterization and Cardiovascular Interventions, Vol. 79, No. 3, 15.02.2012, p. 351-359.

Research output: Contribution to journalArticle

Burzotta, Francesco ; Trani, Carlo ; Todaro, Daniel ; Lanza, Gaetano Antonio ; Mariani, Luca ; Tommasino, Antonella ; Niccoli, Giampaolo ; Porto, Italo ; Leone, Antonio Maria ; Crea, Filippo. / Prospective evaluation of myocardial ischemia related to post-procedural side-branch stenosis in bifurcated lesions treated by provisional approach with drug-eluting stents. In: Catheterization and Cardiovascular Interventions. 2012 ; Vol. 79, No. 3. pp. 351-359.
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abstract = "Objectives: To prospectively assess the impact of post-procedural side-branch (SB) stenosis on inducible myocardial ischemia in patients with bifurcated lesions undergoing percutaneous interventions. Background: Provisional-stenting with drug-eluting stents (DES) is the recommended strategy to treat percutaneously bifurcated lesions but is associated to variable degrees of residual SB stenosis. The role of SB residual stenosis on post-procedural myocardial ischemia is uncertain. Methods: Patients with bifurcations treated by DES according to provisional-stenting technique were enrolled in the study if they had no other untreated lesion. Patients were divided into two groups according to post-procedural 3D-quantitative coronary analysis (3DQCA): group OR (optimal result: stenosis <50{\%} of SB lumen area at 3DQCA) and group SR, suboptimal result: (stenosis ≥ 50{\%} of SB lumen area at 3DQCA). Treadmill exercise stress test (EST) was performed within 1 week from PCI. The primary study endpoint was myocardial ischemia (≥1 mm ST-segment depression at EST). Results: Sixty patients were enrolled: 49 (81.7{\%}) comprised group OR and 11 (18.3{\%}) group SR. Post-PCI myocardial ischemia at EST was inducible in 17 (34.7{\%}) patients of group OR versus 10 (90.9{\%}) patients of group SR (P = 0.0007). During the follow-up, patients of Group SR (vs. Group OR) had a significantly higher occurrence of inducible myocardial ischemia during late (>8 weeks) stress tests (P <0.001). Conclusions: In patients with bifurcated lesions treated by a provisional-stenting technique, residual SB stenosis ≥ 50{\%} at 3DQCA is associated with post-procedural inducible myocardial ischemia at EST.",
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T1 - Prospective evaluation of myocardial ischemia related to post-procedural side-branch stenosis in bifurcated lesions treated by provisional approach with drug-eluting stents

AU - Burzotta, Francesco

AU - Trani, Carlo

AU - Todaro, Daniel

AU - Lanza, Gaetano Antonio

AU - Mariani, Luca

AU - Tommasino, Antonella

AU - Niccoli, Giampaolo

AU - Porto, Italo

AU - Leone, Antonio Maria

AU - Crea, Filippo

PY - 2012/2/15

Y1 - 2012/2/15

N2 - Objectives: To prospectively assess the impact of post-procedural side-branch (SB) stenosis on inducible myocardial ischemia in patients with bifurcated lesions undergoing percutaneous interventions. Background: Provisional-stenting with drug-eluting stents (DES) is the recommended strategy to treat percutaneously bifurcated lesions but is associated to variable degrees of residual SB stenosis. The role of SB residual stenosis on post-procedural myocardial ischemia is uncertain. Methods: Patients with bifurcations treated by DES according to provisional-stenting technique were enrolled in the study if they had no other untreated lesion. Patients were divided into two groups according to post-procedural 3D-quantitative coronary analysis (3DQCA): group OR (optimal result: stenosis <50% of SB lumen area at 3DQCA) and group SR, suboptimal result: (stenosis ≥ 50% of SB lumen area at 3DQCA). Treadmill exercise stress test (EST) was performed within 1 week from PCI. The primary study endpoint was myocardial ischemia (≥1 mm ST-segment depression at EST). Results: Sixty patients were enrolled: 49 (81.7%) comprised group OR and 11 (18.3%) group SR. Post-PCI myocardial ischemia at EST was inducible in 17 (34.7%) patients of group OR versus 10 (90.9%) patients of group SR (P = 0.0007). During the follow-up, patients of Group SR (vs. Group OR) had a significantly higher occurrence of inducible myocardial ischemia during late (>8 weeks) stress tests (P <0.001). Conclusions: In patients with bifurcated lesions treated by a provisional-stenting technique, residual SB stenosis ≥ 50% at 3DQCA is associated with post-procedural inducible myocardial ischemia at EST.

AB - Objectives: To prospectively assess the impact of post-procedural side-branch (SB) stenosis on inducible myocardial ischemia in patients with bifurcated lesions undergoing percutaneous interventions. Background: Provisional-stenting with drug-eluting stents (DES) is the recommended strategy to treat percutaneously bifurcated lesions but is associated to variable degrees of residual SB stenosis. The role of SB residual stenosis on post-procedural myocardial ischemia is uncertain. Methods: Patients with bifurcations treated by DES according to provisional-stenting technique were enrolled in the study if they had no other untreated lesion. Patients were divided into two groups according to post-procedural 3D-quantitative coronary analysis (3DQCA): group OR (optimal result: stenosis <50% of SB lumen area at 3DQCA) and group SR, suboptimal result: (stenosis ≥ 50% of SB lumen area at 3DQCA). Treadmill exercise stress test (EST) was performed within 1 week from PCI. The primary study endpoint was myocardial ischemia (≥1 mm ST-segment depression at EST). Results: Sixty patients were enrolled: 49 (81.7%) comprised group OR and 11 (18.3%) group SR. Post-PCI myocardial ischemia at EST was inducible in 17 (34.7%) patients of group OR versus 10 (90.9%) patients of group SR (P = 0.0007). During the follow-up, patients of Group SR (vs. Group OR) had a significantly higher occurrence of inducible myocardial ischemia during late (>8 weeks) stress tests (P <0.001). Conclusions: In patients with bifurcated lesions treated by a provisional-stenting technique, residual SB stenosis ≥ 50% at 3DQCA is associated with post-procedural inducible myocardial ischemia at EST.

KW - coronary flow

KW - percutaneous coronary intervention

KW - quantitative vascular angiography

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