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Title: | Procedural and Clinical Outcomes in Management of Bifurcational Lesions in ST Elevation Myocardial Infarction. | Authors: | Bogana Shanmugam V.;Malaiapan Y.;Ahmar W.;Tay L.;Psaltis P.J. | Monash Health Department(s): | Cardiology (MonashHeart) | Institution: | (Bogana Shanmugam, Psaltis, Tay, Malaiapan, Ahmar) Monash Heart, Monash Medical Centre, Melbourne, Vic, Australia | Issue Date: | 20-Jan-2020 | Copyright year: | 2020 | Publisher: | Elsevier Ltd | Place of publication: | United Kingdom | Publication information: | Heart Lung and Circulation. 29 (2) (pp 272-279), 2020. Date of Publication: February 2020. | Journal: | Heart Lung and Circulation | Abstract: | Background: Bifurcation percutaneous coronary intervention (PCI) remains a challenging frontier in interventional cardiology, especially in the setting of ST-elevation myocardial infarction (STEMI). We examined the procedural and clinical outcomes of this patient subset. Method(s): We conducted a retrospective case-control study. Between February 2006 and March 2011, 129 patients with STEMI underwent bifurcation PCI at our institution. One hundred and twenty-nine (129) control STEMI patients with non-bifurcation PCI were selected from the institutional database, matched for age, gender, culprit vessel, and lesion location. Patients with cardiac arrest, cardiogenic shock, or who required mechanical ventilation were excluded. Twelve (12)-month follow-up data were collected by telephone calls and examination of the medical records. Result(s): The average age of patients presenting with STEMI was 61.6 +/- 13.1 in the bifurcation group and 61.5 + 31.1 in the non-bifurcation group. There was no difference in lesion type, use of thrombus aspiration catheters, or glycoprotein inhibitors (GPI) among them. Also, the use of drug eluting stent (DES), total cumulative length of stent used, and diameter of the post-dilation balloon were similar. Final kissing balloon post-dilation was performed in 40.3% of bifurcation PCI cases. The incidence of procedural failure (TIMI 0 flow) was 1.5% vs. 0%; p = 0.478. At 12-months follow-up, the bifurcation PCI group had higher incidence of target lesion revascularisation (TLR) (10.9% vs. 3.9%, p = 0.050), mortality (10.1% vs. 2.3%, p = 0.020), and stent thrombosis (9.3% vs. 1.6%; p = 0.013); comprising one acute, nine subacute, and two late vs. two subacute stent thromboses. Conclusion(s): During acute STEMI, bifurcation PCI has excellent acute procedural outcomes, but significantly increased incidence of TLR, stent thrombosis and mortality at 12 months.Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.hlc.2019.01.011 | PubMed URL: | 30850216 [http://www.ncbi.nlm.nih.gov/pubmed/?term=30850216] | ISSN: | 1443-9506 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/35290 | Type: | Article | Subjects: | stent thrombosis/co [Complication] thrombus aspiration balloon catheter drug eluting stent telephone percutaneous coronary intervention adult article case control study controlled study female follow up human incidence major clinical study male medical record mortality outcome assessment priority journal retrospective study revascularization *ST segment elevation myocardial infarction/th [Therapy] stent thrombosis/co thrombus aspiration balloon catheter drug eluting stent telephone percutaneous coronary intervention medical record revascularization ST segment elevation myocardial infarction mortality outcome assessment percutaneous coronary intervention priority journal retrospective study revascularization *ST segment elevation myocardial infarction / *therapy stent thrombosis / complication Article adult thrombus aspiration case control study controlled study female follow up human incidence major clinical study male medical record |
Type of Clinical Study or Trial: | Observational study (cohort, case-control, cross sectional or survey) |
Appears in Collections: | Articles |
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