Impact of bifurcation lesions on angiographic characteristics and procedural success in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Frangos, Caroline; Noble, Stéphane; Piazza, Nicolò; Asgar, Anita W.; Fortier, Annik; Ly, Quoc Hung; Bonan, Raoul

doi:10.1016/j.acvd.2011.02.001

Cited by 12 publications

(9 citation statements)

References 17 publications

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“…We can appreciate that in comparison to the previously mentioned studies, all patients have double guidewire protection with significantly higher percentage of patients managed with two stents strategy (41.1%) of the whole study population in comparison to Frangos et al [11], Salina et al [16] and Abdel-Hakim et al [17].…”

Section: Discussionmentioning

confidence: 66%

“…The technique used in case two stents were used depends mainly on the operator experience and preference according to the lesion criteria as mentioned before. Drug eluting stents (DES) were used in all cases, post dilatation using NC balloons was performed guided by the degree of stent expansion and final kissing balloon inflation was used in provisional stenting in case of SB compromise following MB stent deployment [11,12].…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

“…success: defined as restoration of TIMI flow grade 3 with a residual stenosis of ≤ 30% assessed by quantitative coronary angiography performed at the angiographic core laboratory [11].  Procedural success: defined as technical success without in-hospital major adverse cardiovascular and cerebrovascular events (MACCE) [11].…”

Section: Angiographicmentioning

confidence: 99%

“…-MACCE: defined as the composite of cardiovascular death, recurrent MI, stroke or repeat target vessel revascularization (TVR) [11].…”

Section: Angiographicmentioning

confidence: 99%

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Management of Bifurcation Culprit Lesion in the Setting of Anterior ST Elevation Myocardial Infarction

Amrawy

Assal

Zaki

et al. 2023

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Introduction: Coronary bifurcation lesions are considered one of the challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. However, there is limited data about the proper management of such lesions in the setting of myocardial infarction as most bifurcation lesion studies excluded patients with acute coronary syndromes (ACS). The aim of this study was to compare in-hospital and mid-term outcomes of single-stent and two-stents strategy in the management of bifurcation culprit lesions in patients presenting with anterior STEMI. Methods: This retrospective multi-center study included all patients presented with anterior STEMI who underwent primary PCI between January 2017 and December 2019, coronary angiography showed true bifurcation lesion with sizable side branch that can be managed by stenting. Patients with left main bifurcation, those indicated for urgent CABG, and patients in cardiogenic shock were excluded. Included patients were divided into two groups according to the stenting strategy either single or two stents. Six months follow up data were collected by telephone calls and by examination of medical records. Results: Out of 1355 anterior STEMI patients presented between January 2017 and December 2019, 158 patients (11.6%) were identified to have bifurcation culprit lesions with a sizable diagonal branch. 93 patients (59%) were treated by single stent while 65 patients (41%) were managed by two-stents strategy. The baseline characteristics and angiographic findings were similar in both groups except for higher side branch involvement in the two stents group (83.31%±11.20 vs 71.88%±15.05, t= -5.39, p <0.001). Mean fluoroscopy time (23.96±8.90 vs 17.81±5.72 mins) and contrast volume (259.23± 59.45 vs 232.58± 96.18 ml) were significantly higher in two stents group than single stent group (p=0.049). However, the angiographic success rates (residual stenosis ≤30% and restoration of TIMI flow grade II or III) were comparable (96.8% vs 99%, MCp=0.151). There is no significant difference in the overall incidence rate of MACE in both groups 6 months following the index procedure (13.9 % vs 16.9%, FEp=0.698), with no difference between different bifurcation stenting techniques in patients managed with two stents. Conclusion: Although two stents strategy in the setting of STEMI is much complex with more fluoroscopy time and contrast volume, the procedural success rate and the incidence of MACE were comparable to one stent strategy, on medium-term follow up.

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Section: Discussionmentioning

confidence: 66%

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Section: Angiographicmentioning

confidence: 99%

“…-MACCE: defined as the composite of cardiovascular death, recurrent MI, stroke or repeat target vessel revascularization (TVR) [11].…”

Section: Angiographicmentioning

confidence: 99%

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Management of Bifurcation Culprit Lesion in the Setting of Anterior ST Elevation Myocardial Infarction

Amrawy

Assal

Zaki

et al. 2023

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“…The pathogenesis of CAD remains incompletely understood and both genetic and environmental factors are involved in this complex disease [ 1 , 2 ]. Coronary bifurcation lesion is the most challenging lesion in percutaneous coronary interventional medicine because the rate of restenosis and major adverse cardiac event is significantly higher than nonbifurcation lesion [ 3 ]. MicroRNAs (miRNAs) are key regulators of gene expression that have been widely associated with a variety of diseases [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of Serum MicroRNAs as Potential Biomarker in Coronary Bifurcation Lesion

et al. 2015

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Recent evidence suggests that cell-derived circulating miRNAs may serve as the biomarkers of cardiovascular diseases. However, no study has investigated the potential of circulating miRNAs as biomarker for coronary bifurcation lesion. In this study, we aimed to characterize the miRNA profiles that could distinguish coronary bifurcation lesion and identify potential miRNAs as biomarkers of coronary bifurcation lesion. We employed miRNA microarray to screen serum miRNAs profiles of patients with coronary bifurcation lesion and coronary nonbifurcation lesions. We identified 197 miRNAs differentially expressed, including 150 miRNAs upregulated and 47 miRNAs downregulated. We chose 3 miRNAs with significant differences for further testing in 200 patients. RT-PCR analysis of serum samples confirmed that miR30d was upregulated and miR1246 was downregulated in the serum of coronary bifurcation lesion patients compared with nonbifurcation lesion patients. Our findings suggest that these miRNAs may have a role in the pathogenesis of coronary bifurcation lesion and may represent novel biomarkers for the diagnosis and prognosis of coronary bifurcation lesion.

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The Importance of Bifurcation Lesions in Patients Undergoing Percutaneous Coronary Interventions in ST-segment Elevation Myocardial Infarction

Kanei

Nakra

Liou

et al. 2013

Cardiovascular Revascularization Medicine

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Impact of bifurcation lesions on angiographic characteristics and procedural success in primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Abstract: Despite being challenging lesions, BFLs in STEMI were associated with similar time to reperfusion and procedural success but led to significantly greater contrast use and prolonged procedural time compared with non-BFLs.

Cited by 12 publications

References 17 publications

Management of Bifurcation Culprit Lesion in the Setting of Anterior ST Elevation Myocardial Infarction

Management of Bifurcation Culprit Lesion in the Setting of Anterior ST Elevation Myocardial Infarction

Analysis of Serum MicroRNAs as Potential Biomarker in Coronary Bifurcation Lesion

The Importance of Bifurcation Lesions in Patients Undergoing Percutaneous Coronary Interventions in ST-segment Elevation Myocardial Infarction

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