Crush Stenting With Drug‐Eluting Stents: Relevance of Coronary Bifurcation Lesion Location on Angiographic and Clinical Outcomes |
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| Authors: | Shao‐Liang Chen MD FACC Jun‐jie Zhang MD Fei Ye MD Zhi‐zhong Liu MD Zhong‐sheng Zhu MD Song Lin MD Nai‐liang Tian MD Wei‐yi Fang MD Yun‐dai Chen MD Xue‐wen Sun MD Meng Wei MD Shou‐jie Shan MD Jing Kan MD Jun Qian MD Song Yang MD Zeng‐bai Yuan MD Tak W. Kwan MD FACC Da‐Yi Hu MD |
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| Affiliation: | 1. Nanjing First Hospital, Nanjing Medical University Nanjing, China;2. Beijing Anzhen Hospital, Capital Medical University Beijing, China;3. Shanghai Chest Hospital Shanghai, China;4. Huainan Dongfang Hospital Huainan, China;5. Shanghai 6th Hospital Shanghai, China;6. Maanshan Central Hospital Maanshan, China;7. Yixin People's Hospital, Yixin China;8. Huaibei Mineral General Hospital Huaibei, China;9. People's Hospital, Peking University Beijing, China |
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| Abstract: | Background Data on the relevance of the location of coronary bifurcation lesions treated by crush stenting with outcomes were limited. Hypothesis We hypothesized that the location of the bifurcation lesion correlated with clinical outcome. Method A total of 212 patients with 230 true bifurcation lesions treated by crush stenting with drug‐eluting stents (DES) were assessed prospectively. Surveillance quantitative angiographies were indexed at 8 months after procedure. Primary endpoint was major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, and target lesion revascularization (TLR). Results Patients in the distal right coronary artery (RCAd) group were characterized by higher proportions of prior myocardial infarction and very tortuous lesions. However, lesions in the RCAd group, compared to those of other groups, had the lowest late lumen loss, with resultant lowest incidence of MACE at a mean follow‐up of 268±35 days. Independent predictors of MACE included unsatisfied kissing (KUS; hazard ratio [HR]: 12.14, 95% confidence interval [CI]: 4.01–12.10, P = .001) and non‐RCA lesion (HR: 20.69, 95% CI: 5.05–22.38, P = .001), while those of TLR were KUS (HR: 10.21, 95% CI: 0.01–0.34, P = .002), bifurcation angle (HR: 4.728, 95% CI: 2.541–4.109, P = .001), and non‐RCA lesion (HR: 16.05, 95%CI: 1.01–4.83, P = .001). Conclusions Classical crush stenting with drug‐eluting stents is associated with significantly better outcomes in RCAd. Quality of kissing inflation is mandatory to improve outcome. Copyright © 2009 Wiley Periodicals, Inc. |
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