One-year Outcome of Treating Bifurcation Coronary Artery Disease with Newer Generation Drug-Eluting Stents

Abstract

Objectives: Bifurcation percutaneous coronary interventions (PCIs) remain a challenging subset with tussle between provisional versus dedicated (i.e. two-stent) stenting. Besides technical issues, many other factors such as cost, operator skill, and availability of surgery affect the practice which is followed in a particular region. Because of paucity of data in Indian settings, as also information with later generation stents; this study was planned. Methodology: Patients with bifurcation lesion undergoing elective PCI during 1-year period were prospectively enrolled. Decision of strategy (provisional or dedicated two-stent) and drug-eluting stent type (second or third generation) were operator's choice. Patients were followed telephonically and/or clinically (on routine visits) for 1-year postprocedure for any major adverse cardiac event. Results: One hundred and seven cases (28 in dedicated and 79 in provisional group) with a mean age of 56.2 ± 10.2 years were enrolled. All cases of dedicated arm were true bifurcation compared to 63.2% in provisional group (P < 0.001). In dedicated arm, 75% of patients had stenosis ≥5 mm in side branch (SB), in provisional group, 74.7% had <5 mm stenosis in SB (P < 0.001). T-TAP was most common strategy followed by DK crush and final kissing inflation was done in 96.4% cases of dedicated arm. Nearly 84.1% of patients could be followed up till the end of year. In hospital, events were few in either arm, one patient in the dedicated arm developed acute stent thrombosis and three patients in provisional arm developed in-hospital myocardial infarction. One-year major adverse cardiovascular event (MACE) was not significantly different (9.5% provisional vs. 7.4% dedicated; P = 0.65). Conclusions: One-year MACE did not differ in either 1 or 2-stent strategy in suitable patients with bifurcation lesions.