Impact of acute coronary syndrome classification and procedural technique on clinical outcomes in patients with coronary bifurcation lesions treated with drug-eluting stents Full Text
Clinical Cardiology, 06/29/2012
Song PS et al. – Compared with stable angina patients, the non–ST–segment elevation acute coronary syndrome (NSTE–ACS) patients who underwent bifurcation percutaneous coronary intervention had an increased risk of major adverse cardiac events (MACE) during the 2–year follow–up.Methods
- Authros enrolled 1668 patients, using data from a multicenter real–world bifurcation registry.
- The primary objective was to compare the 2–year cumulative risk of MACE in patients with NSTE–ACS to those with stable angina.
- Major adverse cardiac events were defined as the composite endpoint of cardiac death, myocardial infarction (MI), and target–lesion revascularization.
- Non–ST–segment elevation acute coronary syndrome was seen in 969 (58.1%) patients and stable angina in 699.
- Major adverse cardiac events occurred in 7.3% of NSTE–ACS patients and in 5.2% with stable angina (P = 0.042).
- However, cardiac death, MI, and target–lesion revascularization were similar between the 2 groups.
- Authors stratified patients with NSTE–ACS into those with non–ST–segment elevation MI and those with unstable angina.
- Cumulative risks of 2–year MACEs were 7.0% in non–ST–segment elevation MI patients and 7.5% in unstable angina patients (P = 0.87).
- In the NSTE–ACS cohort, the baseline lesion length in the side branch (adjusted hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01–1.07, P = 0.022), paclitaxel–eluting stents in the main vessel (adjusted HR: 2.02, 95% CI: 1.21–3.40, P = 0.008), and final kissing ballooning (adjusted HR: 1.88, 95% CI: 1.10–3.21, P = 0.021) were independent predictors of MACE.