Predictors and Outcomes of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions

Title
Predictors and Outcomes of Side Branch Occlusion After Main Vessel Stenting in Coronary Bifurcation Lesions
Author(s)
박종선한주영[한주영]천우정[천우정]김지한[김지한]송영빈[송영빈]오주현[오주현]구본권[구본권]나승운[나승운]유철웅[유철웅]정진옥[정진옥]최승혁[최승혁]최진호[최진호]정명호[정명호]윤정한[윤정한]장양수[장양수]탁승제[탁승제]김효수[김효수]권현철[권현철]
Keywords
REAL-WORLD PRACTICE; INTRAVASCULAR ULTRASOUND; ANGIOGRAPHIC PREDICTORS; INTERVENTION; IMPLANTATION; REGISTRY; IMPACT
Issue Date
201310
Publisher
ELSEVIER SCIENCE INC
Citation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.62, no.18, pp.1654 - 1659
Abstract
Objectives This study sought to investigate the predictors and outcomes of side branch (SB) occlusion after main vessel (MV) stenting in coronary bifurcation lesions. Background SB occlusion is a serious complication that occurs during percutaneous coronary intervention (PCI) for bifurcation lesions. Methods Consecutive patients undergoing PCI using drug-eluting stents for bifurcation lesions with SB +/- 2.3 mm were enrolled. We selected patients treated with the 1-stent technique or MV stenting first strategy. SB occlusion after MV stenting was defined as Thrombolysis in Myocardial Infarction flow grade < 3. Results SB occlusion occurred in 187 (8.4%) of 2,227 bifurcation lesions. In multivariate analysis, independent predictors of SB occlusion were pre-procedural percent diameter stenosis of the SB >= 50% (odds ratio [OR]: 2.34; 95% confidence interval [CI]: 1.59 to 3.43; p < 0.001) and the proximal MV >= 50% (OR: 2.34; 95% CI: 1.57 to 3.50; p < 0.001), SB lesion length (OR: 1.03; 95% CI: 1.003 to 1.06; p = 0.03), and acute coronary syndrome (OR: 1.53; 95% CI: 1.06 to 2.19; p = 0.02). Of 187 occluded SBs, flow was restored spontaneously in 26 (13.9%) and by SB intervention in 103 (55.1%) but not in 58 (31.0%). Jailed wire in the SB was associated with flow recovery (74.8% vs. 57.8%, p = 0.02). Cardiac death or myocardial infarction occurred more frequently in patients with SB occlusion than in those without SB occlusion (adjusted hazard ratio: 2.34; 95% CI: 1.15 to 4.77; p = 0.02). Conclusions Angiographic findings of SB, proximal MV stenosis, and clinical presentation are predictive of SB occlusion after MV stenting. Occlusion of sizable SB is associated with adverse clinical outcomes. (C) 2013 by the American College of Cardiology Foundation
URI
http://hdl.handle.net/YU.REPOSITORY/28787http://dx.doi.org/10.1016/j.jacc.2013.07.041
ISSN
0735-1097
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의과대학 > 내과학교실 > Articles
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