Clinical Implications of Bifurcation Angles in Left Main Bifurcation Intervention Using a Two-Stent Technique. (13th July 2020)

• Record Type: Journal Article
• Authors: Ki, You-Jeong; Jung, Ji Hyun; Han, Jung-Kyu; Hong, Sukkeun; Cho, Jang Hyun; Gwon, Hyeon-Cheol; Lee, Sung Yun; Rhew, Jay Young; Chae, Jei Keon; Chae, In-Ho; Yang, Han-Mo; Park, Kyung Woo; Kang, Hyun-Jae; Koo, Bon-Kwon; Kim, Hyo-Soo
• Other Names: Nguyen Thach N. Academic Editor.
• Is Part Of: Journal of interventional cardiology. Volume 2020(2020)
• Publication Date: 2020-07-13
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1155/2020/2475930
• Languages: English
• ISSNs: 0896-4327

Abstract

Abstract : Objectives . The aim of this study was to assess the clinical impact of 3 bifurcation angles in left main (LM) bifurcation treated with the 2-stent technique. Background . Data are limited regarding the impact of bifurcation angles after LM percutaneous coronary intervention (PCI). Methods . Using patient-level 4 multicenter registries in Korea, 462 patients undergoing LM bifurcation PCI with the 2-stent technique were identified (181 crush, 167 T-stenting; 63% 1 st generation drug-eluting stent (DES), 37% 2 nd generation DES). Three bifurcation angles, between the LM and left anterior descending (LAD), the LM and left circumflex (LCX), and the LAD and LCX, were measured. The primary outcome was target lesion failure (TLF), a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR). Results . In patients treated with the crush technique, the best cutoff value (BCV) to predict TLF was 152° of the LM-LAD angle. In the crush group, a significantly higher TLF rate, mostly driven by TLR, was observed in the LM-LAD angle ≥152° group compared with the <152° group (35.7% vs. 14.6%; adjusted hazard ratio 3.476; 95% confidence interval 1.612–7.492). An LM-LAD angle ≥152° was an independent predictor of TLF. In the T-stenting, no bifurcation angle affected the clinical outcomes. Conclusions . In LM bifurcation PCI using the 2-stent technique, wide LM-LAD angle (≥152°) was associated with a greater risk of TLF in the crush, whereas none of the bifurcation angles affected T-stenting outcomes.