Abstract
Percutaneous coronary intervention (PCI) of bifurcation lesions is a technical challenge associated with high risk of adverse events, especially in primary PCI. The aim of the study is to analyze long-term outcomes after PCI for coronary bifurcation in acute myocardial infarction (AMI). The outcome was defined as the rate of major adverse cardiac event related to target lesion failure (MACE-TLF) (death-TLF, nonfatal myocardial infarction-TLF and target lesion revascularization (TLR)) and the rate of stent thrombosis (ST). From 306 patients enrolled to the registry, 113 were diagnosed with AMI. In the long term, AMI was not a risk factor for MACE-TLF. The risk of MACE-TLF was dependent on the culprit lesion, especially in the right coronary artery (RCA) and side branch (SB) with a diameter >3 mm. When PCI was performed in the SB, the inflation pressure in SB remained the single risk factor of poor prognosis. The rate of cumulative ST driven by late ST in AMI was dependent on the inflation pressure in the main branch (MB). In conclusion, PCI of bifurcation culprit lesions should be performed carefully in case of RCA and large SB diameter and attention should be paid to high inflation pressure in the SB. On the contrary, the lower the inflation pressure in the MB, the higher the risk of ST.
Highlights
The optimal strategy for the treatment of coronary bifurcation is rather established, Percutaneous coronary intervention (PCI) of bifurcation as the culprit lesion in acute myocardial infarction (AMI) remains a technical challenge [1], as it carries additional risk deriving from the specificity of acute conditions and the relatively little time for planning the procedure and for the restoration of the blood flow
Registry exclusion criteria were as follows: non-bifurcation lesion on coronary angiogram, treatment of more than one lesion in the same patient, implantation of BMS and lack or insufficient data required for the registry
Angiographic and procedural characteristics of bifurcation lesions recorded for the registry were: diameter, stenosis severity and lesion length of the main branch (MB) and side branch (SB); Medina classification [5]; bifurcation angle; initial and final Thrombolysis in myocardial infarction (TIMI) flow; stenting technique; the use of proximal optimization technique (POT); initial and final kissing balloons; predilatation and postdilatation inflation pressure; maximal inflation pressure in MB and SB; contrast volume; procedure duration; radiation time and dose
Summary
The optimal strategy for the treatment of coronary bifurcation is rather established, PCI of bifurcation as the culprit lesion in AMI remains a technical challenge [1], as it carries additional risk deriving from the specificity of acute conditions and the relatively little time for planning the procedure and for the restoration of the blood flow. Robust data on pathophysiology and advances in treatment, strategy and devices do not fully cover the population of AMI with bifurcation culprit lesion, as these patients are mostly underrepresented in opinion-making trials. There is still insufficient data to allow the formation of strict guidelines for the management of bifurcation culprit lesions in both STEMI and non-STEMI, as well as to decide whether such guidelines are needed or possible.
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