Objectives: The purpose of this study was to analyze from a large prospective database started in 1996, the immediate and mid term results of coronary bifurcation stenting using bare metal stents.
Background: Stenting of bifurcation lesions remains a challenging subset. Various approaches have been advocated and no large prospective studies are available on this subject.
Methods: Between 1996 and 2002, data were prospectively collected on all patients with bifurcation lesions treated with coronary stenting in our institution. Seven-month follow-up data were obtained in 96.7% of patients and coronary angiogram was performed in the presence of clinical or stress test ischemia. The database was analyzed to extract uni-variate and multivariate predictors of acute and 7 months adverse events.
Results: A total of 1,149 patients were included, median age 65 years, 19% diabetic patients, unstable angina in 37.3% of cases and acute MI 10.5%. The target was the LAD-diagonal bifurcation in 53.2% of cases. Angiographic success (residual stenosis < 30%) was obtained in 96.3% of cases for the main branch (MB) and side branch (SB) 92.9 % (residual stenosis < 50%). The in-hospital MACE rate was 4.6 %. At seven months follow-up, a total MACE rate of 18.1% was observed including a target vessel revascularization rate of 13.2% and death rate of 1.6%. By multivariate analysis, independent predictors of MACE at seven month follow-up were unstable angina (OR 5.02 , p = 0.001, 95 % CI : 3.5 - 7.2), type 4 lesion (OR 3.31, p = 0.005, 95 % CI : 1.4 - 7.7), a MB < 2.7 mm (OR 1.8, p = 0.024, 95 % CI : 1.08 - 3.01), non use of a provisional T stenting strategy for the SB (OR 0.48, p = 0.006, 95 % CI : 0.40 - 0.86), and SB stenting (OR 1.48, p = 0.035, 95 % CI : 1.32 - 2.14).
Conclusion: Provisional T stenting strategy applied to the SB is a predictor of favourable outcome after coronary bifurcation stenting using bare metal stents. It significantly reduces the rate of MACE as well as the need for repeat TVR at 7-month follow-up.