Real-world outcome of coronary bifurcation lesions in the drug-eluting stent era: Results from the 4,314-patient Italian Society of Invasive Cardiology (SICI-GISE) Italian Multicenter Registry on Bifurcations (I-BIGIS)

Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

“…Many studies have focused on bifurcation coronary lesions and have reported worst outcome with advancing age [8,[28][29][30]. To assess whether younger age (b45 years) had any impact on outcome, we analyzed data from an Italian multicenter registry of unselected patients undergoing PCI of coronary bifurcations, representing the largest database to date.…”

“…It included both elective and urgent admissions. Data collection and study design have been previously described [8,9]. Briefly, patients undergoing percutaneous revascularization at the site of a coronary bifurcation lesion of a major epicardial coronary artery and eligible for 1-year follow-up were included in the study.…”

“…As previously reported [8,10], bifurcation lesions were defined as presence of >50% diameter stenosis in a major epicardial coronary vessel, involving coronary bifurcation. Main vessel diameter had to be between 2.5 and 4.5 mm, while side branch had to be between 2.25 and 4.5 mm.…”

Is it possible to further improve clinical results with coronary bifurcation stenting, or what is more important — the technique or the stent?

“…Bare-metal stenting without SB stenting had 10% (95% confidence interval [CI] 3-16%, p < 0.01) higher MACE and 10% (95% CI 4-17%, p < 0.01) higher target vessel revascularisation (TVR), whereas bare-metal SB stenting had 31% (95% CI 23-39%, p < 0.001) higher MACE and 19% (95% CI 10-28%, p < 0.001) higher TVR. And finally, the three-year TLR rate from the RESOLUTE studies of 6.9% in bifurcation lesions was even lower than the rate in the Arterial Revascularisation Therapies Study (ARTS) II (9% at one year), the Bifurcations-Bad-Krozingen registry (15% at two years), and the Italian Multicentre Registry on Bifurcations with DES (13% at two years) [3,4,7].…”

“…Although stenting of individual lesions has been shown to be superior to balloon angioplasty, stenting of both branches seems to offer no advantage over stenting of the main branch (MB) alone. The introduction of DESs has resulted in a lower event rate and reduction of MB restenosis in comparison with historical controls [3,4]. Of definite concern is the higher rate of stent thrombosis (ST) early (even during the procedure), late, and very late after interventional procedure (PCI).…”