Akut miyokart enfarktüsü olan hastalarda sorumlu lezyonun bifurkasyon lezyon olma sıklığı ve seçilen tedavi stratejisinin erken ve geç dönem sonuçlara etkisi

Öz

Background: 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. 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.

Anahtar Kelimeler

• Akut koroner sendrom
• bifurkasyon
• revaskülarizasyon
• yan dal kaybı
• mortalite

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

Öz

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.

Anahtar Kelimeler

• Acute coronary syndrome
• bifurcation
• revascularization
• side branch loss
• mortality

Kaynakça

1. 1.Falk E, Shah PK, Fuster V, et al. Coronary plaque disruption. Circulation 1995; 92: 657-71.
2. 2.Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340(2): 115-26.
3. 3.Fuster V, Badimon L, Badimon J, et al. The pathogenesis of coronary artery disease and acute coronary syndromes. N Engl J Med 1992; 326: 242-50.
4. 4.Takebayashi H, Haruta S, Kohno H, et al. Immediate and 3-month follow-up outcome after cutting balloon angioplasty for bifurcation lesions. Journal of interventional cardiology. 2004;17(1):1-7.
5. 5. Yamashita T, Nishida T, Adamian MG, et al. Bifurcation lesions: two stents versus one stent--immediate and follow-up results. J Am Coll Cardiol. 2000;35(5):1145-1151.
6. 6. Third universal definition of myocardial infarction. Jeroen J. Bax, Helmut Baumgartner, Claudio Ceconi, et al. J Am Coll Cardiol. 2012 Oct 16;60(16):1581-98.
7. 7. Sianos G, Morel MA, Kappetein AP, et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1: 219- 27.
8. 8. Chesebro JH, Knatterud G, Roberts R, et al. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. TIMI Study Group. N Engl J Med 1985; 312:932–936.

9. 9.Thomas M, Hildick-Smith D, Louvard Y, et al. Percutaneous coronary intervention for bifurcation disease: A consensus view from the first meeting of the European Bifurcation Club. EuroIntervention 2006; 2: 149–153 )
10. 10.Sang Song P, Ryeol Ryu D, Choi SH, et al.Impact of acute coronary syndrome classification and procedural technique on clinical outcomes in patients with coronary bifurcation lesions treated with drug-eluting stents. Clin Cardiol. 2012 Oct;35(10):610-8.
11. 11.Kim MC, Ahn Y, Sun Sim D, et al. Comparison of the planned one- and elective two-stent techniques in patients with coronary bifurcation lesions with or without acute coronary syndrome from the COBIS II Registry.. Catheter Cardiovasc Interv. 2018;1–11.
12. 12.Hildick-Smith D, de Belder AJ, Cooter N, et al. Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation. 2010;121(10):1235-1243.
13. 13.Chen SL, Santoso T, Zhang JJ, et al. A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DKCRUSH-II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) trial. J Am Coll Cardiol. 2011;57(8):914-920
14. 14.Maeng M, Holm NR, Erglis A, et al. Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: Nordic Bifurcation Study 5-year follow-up results. J Am Coll Cardiol. 2013;62(1):30-34.
15. 15.Colombo A, Bramucci E, Sacca S, et al. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study. Circulation. 2009;119(1):71-78.
16. 16.Lassen JF, Holm NR, Stankovic G, et al. Percutaneous coronary intervention for coronary bifurcation disease: consensus from thefirst 10 years of the European Bifurcation Club meetings. Euro Intervention: journal of Euro PCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2014;10(5):545-560.
17. 17.Cervinka P, Foley DP, Sabate M, et al. Coronary bifurcation stenting using dedicated bifurcation stents. Catheterization and cardiovascular interventions: official journal of the Society for Cardiac Angiography&Interventions. 2000;49(1):105-111.
18. 18.Timurkaynak T, Ciftci H, Ozdemir M, et al. Side branch occlusion after coronary stenting with or without balloon predilation: direct versus conventional stenting. The Journal of invasive cardiology. 2002;14(9):497-501.