SPC365

Percutaneous coronary intervention for true bifurcation lesions: a single-center experience

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Mariana Silva Brandão

Congress: CPC 2021
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters
FP Number: ---
Authors: Mariana S. Brandão; Mariana Ribeiro Da Silva; Alberto Rodrigues; Cláudio Guerreiro; Pedro Ribeiro Queirós; Gualter Santos Silva; Diogo Santos Ferreira; Gustavo Pires-Morais; Bruno Melica; Lino Santos; Pedro Braga; Marco Oliveira; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>BACKGROUND: </strong>Percutaneous coronary intervention (PCI) for true coronary bifurcation lesions is challenging.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM: </strong>To describe procedural and clinical outcomes of true bifurcation PCI.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS:</strong> Single-center retrospective study of consecutive patients (pts) submitted to PCI for true bifurcation lesions (06/2018-06/2020). MACE included death, myocardial infarction (MI), stroke, restenosis and reintervention.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During the study period, 1678 PCI were performed, of which 7% were for true bifurcation lesions (Medina x,x,1). 118 pts (mean age 66.4 &plusmn; 11.0 yrs; 74.6% male; 32.2% diabetic; mean left ventricular ejection fraction 49.8 &plusmn; 8.4%) were included. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Most pts (64.7%) were treated in the setting of an acute coronary syndrome (ACS): 26.7% ST-elevation MI, 31.9% non-ST elevation MI, 6.0% unstable angina. 35.3% were treated for a chronic coronary syndrome. 24.8% of pts presented with 3-vessel disease; 11.1% had a left main (LM) lesion. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The most frequently diseased main branch was the left anterior descending artery: 21.2% (68), followed by the left circumflex: 17.8% (21), right coronary artery: 12.7% (15) and LM: 11.9% (14). In terms of bifurcation classification, lesions were mainly Medina 1,1,1 (71.2%), followed by 0,1,1 (13.6%); 1,0,1 (9.2%) and 0,0,1 (5.9%). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PCI was mainly performed via radial artery (73.7%). Mean number of stents: 1.4 &plusmn; 0.6. Lesions were predominantly treated with single stenting technique (80.3%), regardless the culprit segment. Double-stenting was used in 23 (19.7%) pts: TAP was the most used technique (10), followed by culotte (3), crush (2), DK-crush (2) and T-stent (1). Proximal optimization technique and kissing balloon inflation were performed in 38.1% and 44.9% of pts, respectively. Rotational atherectomy was used in 10.4%. Ventricular support devices were used in 3 pts (1 Impella, 2 intra-aortic balloon pump).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Intracoronary imaging was used in 13 pts: intravascular ultrasound and optical coherence tomography (OCT) in 8 and 5 pts, respectively; its use was more frequent in cases of LM PCI (p=.002). OCT was associated with higher contrast doses (350 <em>vs </em>224 ml, p&lt;.001), with no increase in acute kidney injury incidence (p=.413). Fluoroscopic time (p=.684) and radiation dose (p=.916) did not differ. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Side branch occlusion occurred in 5 pts and iatrogenic coronary dissection in 7 pts. At a mean follow-up time of 17.3 &plusmn; 8.1 months, MACE and mortality rates were 13.3% and 6.9%. MACE occurred more frequently in pts with LM lesion (p&lt;.001) and less often in cases where complete revascularization was achieved (p=.006).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSIONS:</strong> True bifurcations represented a relatively small percentage of treated lesions. Bifurcation PCI was&nbsp;mainly performed in ACS setting. In line with literature, single stenting was the most used technique. MACE rate was globally low and was decreased by complete revascularization. Still, LM bifurcation PCI was associated with increased MACE.</span></span></p>