Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry
Background and Objectives. In most bifurcation lesions, keeping the procedure simple by not treating the side-branch (SB) lesion when possible is considered the best method. However, because of improvements with 2nd generation drug-eluting stents (DESs), it remains unknown whether treatment of the S...
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| Format: | Article |
| Language: | English |
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Wiley
2020-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2020/8858642 |
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| author | Gyu Chul Oh Kyung Woo Park Jeehoon Kang Jung-Kyu Han Han-Mo Yang Hyun-Jae Kang Bon Kwon Koo Hyo-Soo Kim |
| author_facet | Gyu Chul Oh Kyung Woo Park Jeehoon Kang Jung-Kyu Han Han-Mo Yang Hyun-Jae Kang Bon Kwon Koo Hyo-Soo Kim |
| author_sort | Gyu Chul Oh |
| collection | DOAJ |
| description | Background and Objectives. In most bifurcation lesions, keeping the procedure simple by not treating the side-branch (SB) lesion when possible is considered the best method. However, because of improvements with 2nd generation drug-eluting stents (DESs), it remains unknown whether treatment of the SB may improve outcomes in certain subgroups, especially when exclusively using 2nd generation DESs. We report the outcome of SB treatment in a group of patients exclusively receiving newer generation DES for bifurcation PCI. Methods. Patients undergoing PCI to left anterior descending (LAD) bifurcation lesions with contemporary DES were analyzed from a nationwide registry. Baseline risk was assessed using the Age, Creatinine, and Ejection Fraction (ACEF) score. Target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization, was assessed at 3 years. Results. Among 1,089 patients with LAD bifurcation lesions, 548 (50.3%) patients underwent SB treatment. The SB treatment group showed a nonsignificant, but numerically lower rate of 3-year TLF (6.6% vs. 9.2%, HR 0.75, 95%CI 0.44–1.28, p = 0.29). In patients with low pretreatment risk (ACEF<1.22), SB treatment was associated with a lower rate of 3-year TLF (HR 0.43, 95%CI 0.19–0.96, p = 0.04), while no significant difference was observed in patients with high risk (ACEF≥1.22). The difference in the low risk group was mostly driven by target lesion revascularization (HR 0.24, 95%CI 0.08–0.75, p = 0.01). Conclusions. SB treatment for LAD bifurcation lesions showed favorable long-term outcomes compared with main-branch-only intervention, especially in patients with low pretreatment risk. |
| format | Article |
| id | doaj-art-19acb94669214f71967b89ceaf2f362f |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-19acb94669214f71967b89ceaf2f362f2025-02-03T01:28:27ZengWileyJournal of Interventional Cardiology0896-43271540-81832020-01-01202010.1155/2020/88586428858642Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled RegistryGyu Chul Oh0Kyung Woo Park1Jeehoon Kang2Jung-Kyu Han3Han-Mo Yang4Hyun-Jae Kang5Bon Kwon Koo6Hyo-Soo Kim7Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaDepartment of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul 03080, Republic of KoreaBackground and Objectives. In most bifurcation lesions, keeping the procedure simple by not treating the side-branch (SB) lesion when possible is considered the best method. However, because of improvements with 2nd generation drug-eluting stents (DESs), it remains unknown whether treatment of the SB may improve outcomes in certain subgroups, especially when exclusively using 2nd generation DESs. We report the outcome of SB treatment in a group of patients exclusively receiving newer generation DES for bifurcation PCI. Methods. Patients undergoing PCI to left anterior descending (LAD) bifurcation lesions with contemporary DES were analyzed from a nationwide registry. Baseline risk was assessed using the Age, Creatinine, and Ejection Fraction (ACEF) score. Target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization, was assessed at 3 years. Results. Among 1,089 patients with LAD bifurcation lesions, 548 (50.3%) patients underwent SB treatment. The SB treatment group showed a nonsignificant, but numerically lower rate of 3-year TLF (6.6% vs. 9.2%, HR 0.75, 95%CI 0.44–1.28, p = 0.29). In patients with low pretreatment risk (ACEF<1.22), SB treatment was associated with a lower rate of 3-year TLF (HR 0.43, 95%CI 0.19–0.96, p = 0.04), while no significant difference was observed in patients with high risk (ACEF≥1.22). The difference in the low risk group was mostly driven by target lesion revascularization (HR 0.24, 95%CI 0.08–0.75, p = 0.01). Conclusions. SB treatment for LAD bifurcation lesions showed favorable long-term outcomes compared with main-branch-only intervention, especially in patients with low pretreatment risk.http://dx.doi.org/10.1155/2020/8858642 |
| spellingShingle | Gyu Chul Oh Kyung Woo Park Jeehoon Kang Jung-Kyu Han Han-Mo Yang Hyun-Jae Kang Bon Kwon Koo Hyo-Soo Kim Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry Journal of Interventional Cardiology |
| title | Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry |
| title_full | Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry |
| title_fullStr | Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry |
| title_full_unstemmed | Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry |
| title_short | Association of Side-Branch Treatment and Patient Factors in Left Anterior Descending Artery True Bifurcation Lesions: Analysis from the GRAND-DES Pooled Registry |
| title_sort | association of side branch treatment and patient factors in left anterior descending artery true bifurcation lesions analysis from the grand des pooled registry |
| url | http://dx.doi.org/10.1155/2020/8858642 |
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