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CLEAR FILTERS
BIFURCATION PCI – EXPERIENCE FROM A SINGLE CENTER
Session:
Painel 11 - Cardiologia Intervenção 2
Speaker:
Paulo Medeiros
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters
FP Number:
---
Authors:
Paulo Medeiros; Juliana Martins; Carlos Galvão Braga; Isabel Durães Campos; Cátia Costa Oliveira; Carla Marques Pires; Rui Files Flores; Fernando Ribeiro Mané; João Costa; Jorge Marques
Abstract
<p><strong>Introduction</strong>: Percutaneous coronary intervention (PCI) of bifurcation lesions is a challenging procedure and is associated with lower success rates vs. non-bifurcation lesions PCI.</p> <p><strong>Methods:</strong> Single-center descriptive analysis of individuals that underwent coronary bifurcation PCI between January 2015-December/2018. Patients that presented with cardiogenic shock were excluded from the analysis.</p> <p><strong>Results</strong>: A total of 402 patients were included, 79.6% male (n=320) and 20.4% female (n=82). Mean age was 64yo (min 23, max 91). Sixty-two percent had hypertension, 54% hypercholesterolemia, 35% diabetes mellitus and 22% were smokers. Regarding presentation, 36% presented as NSTEMI (n=144), 32% as stable CAD (n=130), 27.6% as STEMI (n=110) and 4.4% as unstable angina (n=18). Coronary angiography identified 1-vessel disease in 39.5% of patients (n=159, 9 with 1-vessel plus left main (LM) disease), 2-vessel disease in 34% (n=136, 16 with 2-vessel plus LM disease) and 3-vessel disease in 26.5% (n=106, 27 with 3-vessel plus LMA disease). The most frequently diseased main branch was the left anterior descending (LAD) artery (63.7%, 23.1 proximal, 39.6% middle and 1% distal), followed by circumflex artery (14.7%, 9.2% proximal, 5.5% distal), LM (8.5%) and right coronary artery (6.9%, 0.2% proximal, 1.5% middle and 5.2% distal). Angioplasty was performed using drug-eluting stents only. In terms of technique, provisional stenting with 1 stent was used in 93% of cases, while 2 stents were used in 7% of cases (n=26, 11 provisional stenting with 2 stents, 7 with cullote technique, 7 with crushing stent and 1 with DK Crush technique). Median radiation dose was 95 mGycm<sup>2 </sup>(IQR=90) and median contrast volume was 150 mL (IQR=100). At a mean follow-up of 22 months, mortality rate was 7.7% (n=31), with about half of patients dying from cardiovascular causes. Twenty patients needed a second PCI, 4 of which due to target-lesion failure -TLF- (3 of them presenting as acute coronary syndromes[ACS]). All patients with TLF were successfully revascularized.</p> <p><strong>Conclusion</strong>: Patients with coronary bifurcation lesions presented mostly as ACS, with >50% angiographies revealing >1-vessel disease. The most frequently affected vessel was the LAD. Supporting the gold-standard approach for bifurcation PCI, provisional stenting with 1 stent was the preferred procedure. TLF rate was about 1% at 22 months; however, as no follow-up angiography was performed, we only identified the TLF associated with symptoms.</p>
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