Impact of the Complexity of Bifurcation Lesions Treated With Drug-Eluting Stents

Abstract

Complex bifurcation lesions had higher rates of 1-year MACE and ST. The 2-stent and PS techniques were overall equivalent in 1-year MACE. However, 2-stent techniques for complex lesions elicited a lower rate of cardiac death and in-hospital MACE but higher rates of in-hospital ST and revascularization at 1 year for simple lesions.

Optical coherence tomography assessment of a complex bifurcation lesion treated with double kissing Crush technique

“…However, DEFINITION relies on coronary angiography, which quite often fails to accurately assess lesion anatomy and severity. [2] OCT can provide unique insights in this setting enabling detailed evaluation of coronary bifurcation pathology and facilitating procedural planning. [3] This is the first case in which we implemented OCT imaging to examine coronary artery pathology and use the DEFINITION classification to guide treatment of a bifurcation lesion.…”

“…The DEFINITION (Impact of the complexity of bifurcation lesions treated with drug-eluting stents) study has provided evidence that complex bifurcation stenting—and in particular double kissing (DK) Crush technique—is associated with better clinical outcomes in lesions with a specific anatomical characteristics assessed by coronary angiography. [2] However, coronary angiography may often fail to evaluate coronary artery pathology. In this case report, we used for the first time optical coherence tomography (OCT)—rather than coronary angiography—to classify lesion severity according to the DEFINITION criteria and assess the immediate and long term results of a DK Crush stenting.…”

Periprocedural myocardial infarction is associated with increased mortality in patients with coronary artery bifurcation lesions after implantation of a drug‐eluting stent

“…The design of the DEFINITION study has been described elsewhere . Briefly, between July 2006 and July 2012, we consecutively enrolled 3,660 patients with coronary bifurcation lesions with side branch (SB) ≥ 2.5 mm classified by Medina 1,1,1 and 0,1,1 ; these patients were prospectively followed for 12 months.…”

“…Recently, the “universal definition” for PMI following PCI has been revised , such that troponin is now recommended as the primary biomarker for the diagnosis of PMI. Unfortunately, specific coronary lesions are not completely addressed in this “universal definition.” Coronary bifurcation stenoses represent a specific subset of atherosclerotic lesions that frequently require complex stenting techniques , resulting in higher PMI rates . At present, only two studies have reported the incidence of PMI after PCI of bifurcation lesions.…”

“…Neither study employed the latest “universal definition” of PMI . Thus, we aimed to examine the frequency of PMI occurrence and one‐year mortality risk in patients undergoing implantation of a drug‐eluting stent (DES) for coronary bifurcation lesions in the prospective DEFINITION study . We defined PMI as an increase in levels of troponin I (TNI), CKMB, or both at thresholds of >5 to >10 times the 99th percentile of the URL.…”