Comparison of the planned one‐ and elective two‐stent techniques in patients with coronary bifurcation lesions with or without acute coronary syndrome from the COBIS II Registry

Kim, Min Chul; Ahn, Youngkeun; Sim, Doo Sun; Hong, Young Joon; Kim, Ju Han; Jeong, Myung Ho; Gwon, Hyeon Cheol; Kim, Hyo Soo; Rha, Seung Woon; Yoon, Jung Han; Jang, Yangsoo; Tahk, Seung Jea; Seung, Ki Bae

doi:10.1002/ccd.27551

Cited by 7 publications

(5 citation statements)

References 27 publications

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“…Acute coronary syndrome is a stage where coronary plaques become unstable ( 25 ). The COBIS Registry showed a lower rate of 3-year TLF after the PS approach for patients with ACS but no difference between the PS and upfront 2-stent for patients without ACS ( 26 ), confirmed by another study of Korean team which further found that SB lesion length was an independent factor of TLF ( 27 ). The underlying mechanisms for a higher rate of TLF in patients with ACS were multifactorial, of them DAPT might be one major reason ( 25 ).…”

Section: Discussionmentioning

confidence: 76%

Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions

Sheiban

Kan

et al. 2022

Front. Cardiovasc. Med.

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BackgroundProvisional stenting (PS) is the main treatment for a majority of coronary bifurcation lesion and includes PS with 1-stent and PS with 2-stent. However, the treatment difference between PS with 1-stent and with 2-stent remains unclear in patients with the acute coronary syndrome (ACS) and coronary bifurcation lesions.Materials and methodsOverall, 820 ACS patients with Medina 1,1,1 or 0,1,1 coronary bifurcation lesion who had completed 3-year follow-up were included and assigned to the PS with 1-stent (n = 519) or the PS with 2-stent (n = 301) according to the use of final stenting technique. The primary endpoint was the target lesion failure (TLF) at 3 years since stenting procedures.ResultsAt 3-year follow-up, TLF occurred in 85 (16.4%) patients in the PS with 1-stent group and 69 (22.9%) in the PS with 2-stent group (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.06–2.17, p = 0.021), mainly driven by a higher rate of target lesion revascularization (TLR) in the PS with 2-stent group (13.0% vs. 8.3%, HR 1.65, 95% CI 1.04–2.61, p = 0.033). Complex bifurcations, side branch (SB) pretreatment, intravascular imaging guidance, and hyperlipidemia were the four predictors for 3-year TLF. SB pretreatment was associated with increased 3-year TLR, leading to an extremely higher 3-year TLF.ConclusionProvisional with 2-stent for patients with ACS is associated with a higher rate of 3-year TLF, mainly due to increased requirement of revascularization. SB pretreatment should be avoided for simple bifurcation lesion.

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Section: Discussionmentioning

confidence: 76%

Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions

Sheiban

Kan

et al. 2022

Front. Cardiovasc. Med.

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“…Implantation of no more than one stent was observed in 70% of patients, although patients with multi-vessel disease represented almost two-thirds of the analyzed group. Such an approach in which a lower number of stents is preferred may be one of the reasons why satisfactory outcomes were achieved in those patients, as the reduced range and complexity of the intervention decreased the risk of complications [16,17] consideration of paramount importance in the vulnerable elderly population. However, the combined length of stents per procedure was relatively long, mean fluoroscopy exposure was elevated, and mean contrast volume was high, which suggests that although a relatively low number of stents were implanted per procedure, those procedures remained difficult, time-consuming and laborious [18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Association between baseline characteristics and clinical outcomes among the elderly undergoing PCI – retrospective cohort study

Wawrzeńczyk,

Kuciński,

Kuleta

et al. 2023

Med Og Nauk Zdr.

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Introduction and Objective. Percutaneous coronary intervention (PCI) is the method of choice for the treatment of coronary artery disease or acute coronary syndromes, but clinicians often refrain from performing it on elderly and/or frail patients. The aimed of the study was to determine the feasibility of PCI in the elderly, and define characteristics of significant stenoses and clinical outcomes of those procedures. Materials and method. A retrospective analysis was conducted on a total of 150 patients aged ≥70 years, who were admitted and underwent PCI between November 2020 -December.2021. Also investgated was the impact of patients' baseline characteristics, such as: gender, body mass index (BMI) or comorbidities: hyperlipidaemia, hypertension, diabetes, etc. on clinical outcomes of PCI performed in the elderly.Results. The mean age was 77.5 ± 7.1 years, 65.33% were male. The average BMI was 27.5 ± 4.3, 92.00% had a history of HT. The majority of patients (n=84) were treated for acute coronary syndromes (ACS). The mean length of stents implanted in one procedure was 31mm. The TIMI 3 flow was achieved in 94.67% of cases. Combined intra-procedural and in-hospital mortality was 2.67%. Conclusions. Complex PCI may be successfully and safely performed among elderly patients who frequently suffer from severe myocardial ischemia and carry a substantial comorbidity burden. Age itself cannot warrant disqualification from interventional management of coronary artery disease. Gender and BMI are potential factors that influence clinical outcomes.

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“…It showed that adverse cardiac events were significantly more common with the two-stent technique than the provisional technique in patients with ACS, as opposed to the patients without ACS. Although it should be taken into consideration that this was not a randomized study and that lesions treated with the implantation of two stents had a higher prevalence of more complex lesions, true bifurcations, left main stem (LMS) lesions as well as multivessel disease [7].…”

Section: Discussionmentioning

confidence: 99%

“TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock

et al. 2021

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Introduction. Bifurcation lesions on venous Y grafts are rare. We presented a case of a woman who developed NSTEMI complicated by cardiogenic shock due to a bifurcation lesion on the venous Y graft for LAD and RCX. Case outline. A 72-year-old woman was admitted to the CCU as an emergency in September 2017 due to the acute heart failure followed by the development of cardiogenic shock. Urgent coronarography revealed severe atherosclerotic disease of native coronary arteries with significant bifurcation lesion on venous Y graft for LAD and RCX (medina classification of 1,1,1) with TIMI 2 flow. According to the general condition of patient, a life-saving ad hoc PCI was performed. Two stents were implanted in Y graft with T and protrusion technique achieving optimal result followed with patient stabilization. On one-year follow-up patient was without symptoms of angina, and CT coronarography revealed patent both stents in Y graft. Best to our knowledge this was the first described TAP technique used on Y graft. Conclusion. The PCI on VG is not uncommon either in elective cases or in cases with ACS due to the poorer persistence and more frequent progression of atherosclerotic disease in the venous grafts. The use of bifurcation techniques for the treatment of lesions on VG and especially on the Y graft is rare, but it can be used the same way it is used in native vessels.

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Comparison of the planned one‐ and elective two‐stent techniques in patients with coronary bifurcation lesions with or without acute coronary syndrome from the COBIS II Registry

Abstract: Planned one-stenting reduced TLF in patients with ACS and it also might be beneficial in those without ACS for the treatment of coronary bifurcation lesions.

Cited by 7 publications

References 27 publications

Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions

Provisional stenting with side branch rescue stenting is associated with increased 3-year target lesion failure in patients with acute coronary syndrome and coronary bifurcation lesions

Association between baseline characteristics and clinical outcomes among the elderly undergoing PCI – retrospective cohort study

“TAP” technique on bifurcation lesion of Y graft in a patient with NSTEMI complicated with cardiogenic shock

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