SPC365

Bifurcation lesions and stent diameter: is it the bigger the best?

Session: Posters - H. Interventional Cardiology and Cardiovascular Surgery
Speaker: Carolina Saleiro

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: Carolina Saleiro; Joana m Ribeiro; Diana de Campos; João Lopes; José p Sousa; Ana rm Gomes; Joana Silva; Luís Paiva; Hilário Oliveira; Marco Costa; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: &nbsp;</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Vessel size is a determinant of long-term outcomes after coronary stenting: smaller target vessel diameter has been reported as a predictor of adverse outcomes. There is a scarcity of information about the specific role of stent diameter in complex lesions such as bifurcations. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;<strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">To compare the characteristics and outcomes of bifurcation lesions according to main vessel (MV) stent diameter.<strong> </strong></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">402 consecutive bifurcation PCIs (360 patients) at a single centre between 2010-2017 were included. C<span style="color:black">linical and procedural data and events during follow-up were evaluated. Two groups were created based on MV stent diameter: Group A &ndash; stent diameter &lt;3.5mm (N=276) and Group B &ndash; stent diameter &ge;3.5mm (N=126). The primary co-endpoints were periprocedural complications and all-cause long-term mortality. Median follow-up time was 31 (14-53) months. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">75% of the procedures were performed in male patients, with a mean age of </span></span>69&plusmn;10 <span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">years old. Comorbidity with dyslipidaemia (73%), arterial hypertension (73%); diabetes (38%) and tobacco usage (24%) were frequent. Patients in group B were younger (70</span></span>&plusmn;<span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">11 vs 66</span></span>&plusmn;<span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">10 years old, P=0.026) and were more frequently smokers (24% vs 36%, P=0.021); other baseline characteristics were balanced between groups. The indication for revascularization was chronic coronary syndrome in 62% of the cases and the main vessel was left anterior descendent in 51%; left circumflex in 23%; left main in 12%; right coronary artery in 3%. The preferred technique was provisional stenting (67%; no difference between groups), and most of patients received only one stent (65%). Drug eluting stents were used in 85% and the mean length of treated vessel was 23&plusmn;11 mm. TIMI 3 flow after procedure was achieved in 98%. Intracoronary imaging was mostly performed in the group treated with larger stents (5% vs 18%, P&lt;0.0001). &nbsp;Fluoroscopy time, radiation and contrast dosages were similar between groups. Periprocedural myocardial infarction occurred in 32% of the cases; dissection in 7%, intraprocedural stent thrombosis and no-reflow in &lt;1%; there was no difference in complications between groups. 56 patients died during follow-up. Kaplan-Meyer curves showed an increased survival among patients treated with larger stents (58 vs 63, Log RanK P=0.04 &ndash; Figure 1). <span style="color:black">After adjustment for the bifurcation technique performed (provisional vs no provisional), the use of </span>stent <span style="color:black">&ge;3.5mm still showed a tendency to halve mortality &ndash; (HR 0.52, 95% CI 0.28-1.003, P=0.053). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> In our cohort, stent diameter did not predict periprocedural complications. However, patients with a larger MV diameter had an increased long-term survival. &nbsp;&nbsp;</span></span></span></span></p>