Revista argentina de cardiología
versión On-line ISSN 1850-3748
ALBERTAL, Mariano et al. Outcomes of Percutaneous Coronary Interventions in Coronary Artery Bifurcation Lesions. Rev. argent. cardiol. [online]. 2008, vol.76, n.5, pp. 341-346. ISSN 1850-3748.
Background Drug-eluting stents (DESs) have reduced the target lesion revascularization (TLR) rate. Percutaneous coronary interventions in coronary artery bifurcation lesions are still a challenge, even in the DESs era, due to a high TLR rate. Objective To assess the clinical outcomes in patients with coronary artery bifurcation lesions treated with DESs in a high-volume center. Material and Methods From April 2003 to August 2006, 1,910 percutaneous coronary interventions were performed; 235 patients (12.3%) presented coronary artery bifurcation lesions. Results Patients characteristics were as follows: mean age was 62±11 years, 86% were men, 19.2% had diabetes mellitus and 22.7% had a history of coronary artery bypass graft surgery. Fifty-four percent of patients presented true bifurcation lesions. DESs were implanted in 44.3% of cases; two stents were placed in both branches in 22.5% of patients, and a final kissing balloon concluded 24.5% of the procedures. At late follow-up (median 430 days) TLR rate was 16.7%, 13.9% with DESs and 17.2% with bare-metal stents (p=ns). The rate of angiographic stent thrombosis was 3%, 1.9% for DESs and 4.6% for bare-metal stents (p=ns). No differences were observed between both groups in the incidence of infarction and cardiovascular mortality (3.4% for DESs and 2.9% for bare-metal stents). The combined rate of cardiovascular mortality, infarction, thrombosis and TLR was 16.3% in patients with DESs and 25.2% in the bare-metal stents group (p=0.04). Conclusion Percutaneous coronary interventions in coronary artery bifurcation lesions are still a challenge. Probably, in most cases it would be better to perform the simplest techniques -placement of only one stent, preferably a DES- with a final kissing balloon.
Palabras clave : Coronary Vessels; Angioplasty; Stent.