Strategies for drug‐eluting stent treatment of bifurcation coronary artery disease in the United States: Insights from the e‐Cypher S.T.L.L.R.Trial |
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| Authors: | Nobuaki Suzuki MD Dominick J Angiolillo MD PhD FACC FESC Mark A Tannenbaum MD Mitchell H Driesman MD Conrad Smith MD Mahesh Bikkina MD MPH FACC Clyde R Meckel MD FACC Carlos E Morales MD FACC Nicholaos P Xenopoulos MD John E Coletta MD Hiram G Bezerra MD PhD Theodore A Bass MD FSCAI FACC Marco A Costa MD PhD FSCAI FACC |
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| Institution: | 1. Division of Cardiology and Cardiovascular Imaging Core Laboratories, University of Florida College of Medicine‐Jacksonville, Jacksonville, Florida;2. Harrington‐McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio;3. Mercy Medical Center, Iowa Heart Center, Des Moines, Iowa;4. The Heart Institute, Bridgeport Hospital, Bridgeport, Connecticut;5. The Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;6. St. Joseph's Cardiovascular Institute, St. Joseph's Regional Medical Center, Paterson, New Jersey;7. BryanLGH Heart Institute, Lincoln, Nebraska;8. McAllen Medical Center, McAllen, Texas;9. Heart and Lung Institute, Jewish Hospital, Louisville, Kentucky |
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| Abstract: | Objectives: Our goal is to report the first large multicenter data for percutaneous coronary intervention (PCI) of bifurcation disease with drug‐eluting stents (DES) in the United States. Background: Bifurcation PCI remains a challenge to this date. There are limited data on outcomes of patients treated with bifurcation DES implantation, particularly in the United States. Methods: There were 161 patients with bifurcation disease side branch (SB) ≥2‐mm] treated with ≥1 sirolimus‐eluting stents at 41 centers participating in the Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheR?stent (STLLR) trial. There was no protocol mandated strategy for bifurcation PCI. One‐year outcome data were collected. Angiographic and clinical data were adjudicated independently. Results: There were 147 patients (91.3%) treated with single stent strategy. Only 14 (8.7%) patients received sirolimus‐eluting stents implantation in both branches. Among patients with single stent strategy, double wire strategy (DW) was selected in 27 (18.4%) patients whereas single wire strategy (SW) was selected in 120 (81.6%) patients. There were 48 (32.7%) Medina 1,1,1 bifurcations treated with SW (n = 34; 70.8%) and DW (n = 14; 29.2%). There were 26 procedures started with SW which had SB dilatation during the procedure, one as a bailout (TIMI‐1 grade flow in the SB). Overall 1‐year death, myocardial infarction, and target lesion revascularization occurred in 2.4, 4.0, and 5.6%, respectively. There was no significant difference in clinical outcomes between SW and DW. SB dilatation was associated with a high rate of stent thrombosis (8.6%). Conclusions: Main branch stenting without SB protection is the most common approach utilized in the STLLR study, which may reflect contemporary DES bifurcation strategies in the Unite States. This strategy was associated with an acceptable low incidence of adverse outcomes at 1‐year. © 2009 Wiley‐Liss, Inc. |
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| Keywords: | percutaneous coronary intervention quantitative coronary angiography angiography‐coronary |
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