SPC365

Having a crush for double kissing: Bifurcation technique performance and outcomes

Session: Posters (Sessão 3 - Écran 8) - Intervenção coronária
Speaker: Marta Miguez Vilela

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 12. Coronary Artery Disease (Chronic)
Subtheme: 12.4 Coronary Artery Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Marta Miguez De Freitas Vilela; Pedro Alves da Silva; Joana Brito; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Abrantes; Catarina Gregório; Fernando Ribeiro; Tiago Rodrigues; Ana Rita Francisco; Pedro Carrilho Ferreira; Fausto J. Pinto; Pedro Cardoso

<p><span style="font-family:Calibri"><strong><span style="font-size:12,0000pt"><span style="font-family:Calibri"><strong>Introduction</strong></span></span></strong><span style="font-size:12,0000pt"><span style="font-family:Calibri">: Lesions involving bifurcations can be complex and technically challenging. Provisional stenting is the preferred and recommended stenting strategy for most coronary bifurcation lesions; however, two-stent techniques are often needed in lesions with a large, diseased side branch (SB) and, in this cases, double kissing (DK) balloon technique as gained popularity following publication of DK-CRUSH I-V trials. </span></span></span></p>

<p><span style="font-family:Calibri"><strong><span style="font-size:12,0000pt"><span style="font-family:Calibri"><strong>Purpose</strong></span></span></strong><span style="font-size:12,0000pt"><span style="font-family:Calibri">: To analyze real-world performance of DK crush effectiveness and safety and to define predictors of adverse events during follow-up.</span></span></span></p>

<p><span style="font-family:Calibri"><strong><span style="font-size:12,0000pt"><span style="font-family:Calibri"><strong>Methods:</strong></span></span></strong><span style="font-size:12,0000pt"><span style="font-family:Calibri">&nbsp;Single center, observational, retrospective study, including pts who underwent bifurcation lesion angioplasty with DK crush technique from 2014 up to 2020. Clinical and laboratorial data were collected as well as procedure characteristics, after proper selection by a hemodynamic fellow. Chi-square analysis and Cox regression was used to determine preditors of mortality.</span></span></span></p>

<p><span style="font-family:Calibri"><strong><span style="font-size:12,0000pt"><span style="font-family:Calibri"><strong>Results:</strong></span></span></strong><span style="font-size:12,0000pt"><span style="font-family:Calibri">&nbsp;We gathered 100 pts who performed bifurcation angioplasty using DK crush technique. 80% of pts were male, mean age 66</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">&plusmn;</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">11 years-old. Regarding main comorbidities, 77% had hypertension, 55% had dyslipidemia (mean basal LDL-c level 108</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">&plusmn;</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">43mg/dL), 39% diabetic, 34% were smoker or former smoker. Previous coronary disease was known in 36% pts, most of which have had prior PCI (55%) or CABG (17%).</span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:12,0000pt"><span style="font-family:Calibri">Most cases were done in context of stable coronary disease (58%) and the remainder were performed in cases of NSTEMI (22%), STEMI (14%) and unstable angina (6%); median Killip Class was 1 and mean Syntax score was 22,17</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">&plusmn;</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">12,5.</span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:12,0000pt"><span style="font-family:Calibri">In respect to procedure aspects, anterior descending artery (ADA) branching for diagonal was the most common indication &ndash; figure 1. Final procedure TIMI 3 was achieved in 99% pts. Complications occurred in 9 cases &ndash; 7 dissections, 1 perforation and 1 stent hyperexpansion. There were no deaths in the first 24h after procedure.</span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:12,0000pt"><span style="font-family:Calibri">During a mean follow-up of 5,34</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">&plusmn;</span></span><span style="font-size:12,0000pt"><span style="font-family:Calibri">0,3 years, 35 pts repeated cath. New PCI was done in 11 patients, in 5 for lesions on previously treated vessels with DK. Of these, 4 had restenosis (3 in ADA-&gt;Diag) and 1 had a very late stent thrombosis (ADA-&gt; Diag). </span></span></span></p>

<p><span style="font-family:Calibri"><span style="font-size:12,0000pt"><span style="font-family:Calibri">Event (defined as new PCI or cardiovascular death) rate during follow-up was 19%. Mean ejection fraction (p=0.005) at time of DKC technique, SYNTAX score (p=0.036) and complications during procedure (p=0.047) correlated with events during follow-up. However, on multivariate Cox analysis only SYNTAX score was the only independent predictor of events (HR 1.046 [1.010-1.084], p=0.013).</span></span></span></p>

<p><span style="font-family:Calibri"><strong><span style="font-size:12,0000pt"><span style="font-family:Calibri"><strong>Conclusion:</strong></span></span></strong></span></p>

<p><span style="font-family:Calibri"><span style="font-size:12,0000pt"><span style="font-family:Calibri">Double kissing balloon technique was preferentially used in bifurcations involving anterior descending artery and diagonal branch. Syntax score was the sole independent predictor of events suggesting that coronary artery disease complexity rather than procedure characteristics define long term prognosis</span></span></span></p>