P969Predictors of survival after bifurcation stenting (practical insights from COSIBRIA registry)

Abstract

Abstract Background There is no much information about survival after coronary bifurcation stenting. We explored specifically predictors of death in all-comers registry database. Methods The COSIBRIA registry (COronary SIde Branch Residual IschemiA and COllateralization Assessment Study, Identifier: NCT01268228) collected all coronary bifurcation patients treated with intracoronary ECG (icECG) guidance or angiographically guided PCI. It was designed to explore relation between periprocedural ischemia assessed by means of icECG and post-procedural myonecrosis (troponin rise). Patients with STEMI, distal left main, cardiogenic shock or hemodynamic instability or BVS implantations were excluded. Unipolar icECGs were recorded before, during and after stent placement and at the end of procedure in side branch (SB) and main branch (MB). The coronary wire was placed in all distal vessels with diameter >1.5mm, to “map” the distal zones of ischemia. Provisional T-stenting, with proximal balloon optimization (POT) after stent implantation was default strategy. SB was stented in case of non-normalization of icECG ST-segment elevation after kissing-balloon dilatation or flow compromise and severe dissection (>type C) associated with symptoms. All patients were treated with 3rd and higher generation drug-eluting stents. Results 731 patients were included in the analysis recruited from 01.08.2014 to 31.12.208 – 321 (44%) icECG guided. The mean age of patients was 67±10 years, 68% males, 38% smokers, 94% dyslipidemic, 41% diabetics, 26% had previous MI, 47% previous PCI, previous CABG 3%, renal failure 32%, cerebrovascular and peripheral artery disease – 15% and 10%. At median follow-up of 28 months (IQR 18–45 months), 110 patients died (15%): icECG-guided vs. angio guided (18.1% (58/321) vs. 12.7% (52/410), p=0.043, log-rank p=0.045). Side branches were stented in 27%. On univariate analysis significantly associated with mortality were: age, sex, COPD, renal failure, total cholesterol, atrial fibrillation, cerebrovascular disease, ejection fraction (EF), mitral regurgitation >1st degree, SB stenting, kissing balloon inflation, stent length, lesion location (LAD), SYNTAX score. On Cox-regression analysis an independent predictors of survival were: age (HR=1.033, CI: 1.011–1.055, p<0.001), male sex (HR=1.733, CI: 1.056–2.845, p=0.030), COPD (HR=0.586, CI: 0.349–0.985, p=0.044), EF (HR=0.972, CI: 0.953–0.992, p=0.006), MR>1 (HR=1.617, CI: 1.224–2.136, p=0.001), SB stenting (for non-stent implantation HR=0.497, CI: 0.300–0.824, p=0.007). Conclusions Even with modern treatment of coronary bifurcations the demographic factors and parameters of left ventricular function governs the patient survival. The only technical factor associated with survival was implantation of stent in SB, associated with worse survival. Intracoronary ECG guided PCI was not independently associated with survival.