Age influence on the results of the treatment of complex coronary bifurcated lesions using the mini-crush two-stent technique

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction There is limited evidence about the benefit of "double stenting" techniques over "provisional stenting" in percutaneous coronary intervention (PCI) of complex coronary bifurcation lesions. Elderly patients (>75 years) represent an unfavourable high-risk subgroup that have typically been under-represented in cardiovascular clinical trials. Purpose The aim of this study was to evaluate the influence of age on the rate of major adverse cardiovascular events (MACE): cardiovascular mortality, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after prolonged follow-up (median 32 months). Methods Observational study in wich were included 152 consecutive patients (mean age 69.5 years, 73.7% male) with 152 complex bifurcated coronary severe lesions that underwent PCI with "mini-crush" two-stent technique and in which were compared the subgroup of elder patients (>75 years) from April 2014 to April 2020. Results The 53.3% of patients had stable coronary disease and 46.7% acute coronary syndrome (30.1% Non-STEMI and 16.6% STEMI). 35% of patients were >75 years old. We observed a significantly higher proportion of nonsmokers (51.2%), diabetics (38.8%) and hypertensive patients (75.3%). Clinical presentation, basal featured characteristics and antiplatelet pretreatment was similar in both groups. Mean Syntax score was higher in the older group (33.9 ± 13.7 vs. 28.1 ± 12.7, p=0.035). Left main bifurcation was the most frequently coronary artery affected in both groups and circumflex was the most common side vessel. There were no differences in pre-dilation rate either in final kissing balloon post-dilation rate. There were also no differences in the length and diameter of stents implanted and zotarolimus stent was the most commonly used in both groups as well as in the main vessel and in side branch. MACE incidence was higher in the older group (19.3% vs 8.4%, p=0.05), due to higher cardiovascular mortality (10.5% vs 2.1%, p=0.024). There were no differences in the remaining components separately. Conclusions Elderly patients with complex bifurcation coronary severe lesions treated with "mini-crush" technique had higher cardiovascular mortality at long-term follow-up compared with younger patients. There were no differences in other lesion-related outcomes.