Incidence of bifurcation coronary lesion as a culprit lesion in patients with acute myocardial infarction: impact of treatment strategy on short and long term outcomes
Abstract
Abstract
Purpose: Although, there are several studies comparing single and two-stent techniques in patients with
bifurcation lesions, evidence in patients presenting with myocardial infarction (MI) is still insufficient. We aimed
to assess the short and long term outcomes of provisional and two-stent techniques of bifurcation lesions in
patients with ACS.
Materials and methods: 2992 patients with MI who underwent percutaneous coronary intervention (PCI) were
enrolled in the present study. Of 2992 patients, 385 patients with MI had bifurcation lesions. The Synergy
between PCI with TAXUS™ and Cardiac Surgery (SYNTAX) score, pre-PCI Thrombolysis in Myocardial
Infarction (TIMI) flow, post-PCI TIMI flow, duration of procedure, angiographic features, post-PCI side branch
loss, 1- and 12-month mortality rates were noted.
Results: 169 (43.9%) patients had ST segment elevation MI, whereas 216 (56.1%) patients had non-ST segment
elevation MI. 355 (92.2%) patients underwent provisional stenting and 30 (7.8%) patients underwent two-stent
technique. Side branch loss was observed in 40 patients (11.2%) in the provisional group and 1 patient (3.3%)
in the two-stent group (p=0.2). Compared to provisional group, durations of angiography and revascularization
in two-stent group were significantly longer (p<0.001 and p<0.001). Both 1-month and 12-month mortality
rates were similar in provisional and two-stent groups (4.2% vs. 3.3%, p=0.8 and 11.5% and 13.3%, p=0.7;
respectively).
Conclusion: In patients presenting with ACS and bifurcation lesions, procedural success, side branch loss, as
well as short and long term mortality were similar in both provisional and two-stent techniques.
Keywords
Acute coronary syndrome, bifurcation, revascularization, side branch loss, mortality
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