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Dedicated stents for coronary bifurcation lesions: precision medicine vs. precision engineering
Session:
Painel 11 - Cardiologia Intervenção 2
Speaker:
José Pedro Sousa
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:
José Pedro Sousa; Joana M. Ribeiro; Luís Puga; João Gameiro; Carolina Saleiro; Ana Rita M. Gomes; Diana Decampos; Marco Costa; Lino Gonçalves
Abstract
<p>Background: Coronary bifurcation plaques are associated with lower procedural success and more cardiac events. Particular stents (BS), such as Tryton (TS), have been developed specifically for their treatment. However, the TRYTON trial, which compared TS with a provisional technique (PS), did not meet its primary endpoint. In turn, real-world evidence in this setting is scant.</p> <p>Purpose: To ascertain the differential impact of BS in percutaneous coronary intervention (PCI) of bifurcation lesions, concerning procedural aspects and both immediate and long-term outcomes.</p> <p>Methods: Retrospective study encompassing patients consecutively referred to a tertiary interventional cardiology unit, for coronary angiography, who were found to have at least 1 true native bifurcation lesion, defined as Medina classes 1,1,1, 1,0,1 or 0,1,1. According to operator experience and angiographic features, patients were managed either with a BS or with regular stents (non-BS), in a single- or two-platform strategy. Procedural aspects regarding radiological variables, angiographic success and immediate complications were reviewed, as were in-hospital outcomes. Clinical follow-up, by clinic appointment or telephone calling, was performed targeting stent failure, target vessel revascularization (TVR), acute coronary syndromes (ACS), heart failure and mortality.</p> <p>Results: From January 2010 to June 2017, 252 patients with 277 lesions were included. Median age was 68 (62-74) years and 21.2% were female. Median follow-up was 2 (1-4) years. Chronic angina was the dominant PCI context (51.5%), while 9.9% of patients presented with ST-segment elevation myocardial infarction (MI). 40 patients underwent BS implantation, namely TS (30), Axxess (9) and BiOSS LIM (1), whereas 158 were managed with PS and 24 with a two-stent technique. A BS was preferentially applied to Medina class 1,1,1 lesions [adjusted standardized residual 2.5], whereas ACS presentation displayed a trend towards a non-BS strategy (p=0.087). Although fluoroscopy time, radiation dose and contrast volume did not differ, OCT guidance was further utilized in the BS group (p=0.011). Angiographic success was uniformly high (over 93.5%) and procedural complications, even though quite frequent (12.3%, mostly iatrogenic dissections), also seemed homogeneous. Likewise, type 4a MI was fairly common (35.1%), irrespective of stent nature. However, stent failure, particularly via restenosis (7.1%), occurred more often with BS (p=0.047), with TVR (14.2%) following the same trend (p=0.063). In turn, rates of ACS (12.3%), heart failure hospitalization (5.8%) and mortality were similar.</p> <p>Conclusion: BS may increase the odds of stent restenosis and TVR. These findings might have been driven by the bare-metal nature of TS, the study’s most represented BS.</p>
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