Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:801-10 - Vol. 71 Num.10 DOI: 10.1016/j.rec.2017.06.022

Bifurcation Culprit Lesions in ST-segment Elevation Myocardial Infarction: Procedural Success and 5-year Outcome Compared With Nonbifurcation Lesions

Pablo Salinas a,, Hernán Mejía-Rentería a, Raúl Herrera-Nogueira a, Pilar Jiménez-Quevedo a, Luis Nombela-Franco a, Iván Javier Núñez-Gil a, Nieves Gonzalo a, María del Trigo a, María José Pérez-Vizcayno a, Alicia Quirós a, Javier Escaned a, Carlos Macaya a, Antonio Fernández-Ortiz a

a Sección de Hemodinámica, Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain

Refers to

Bifurcation Lesions Causing an STEMI. Are They a Different Animal?
Manuel Pan, Soledad Ojeda
Rev Esp Cardiol. 2018;71:779-81
Full text - PDF

Keywords

ST-segment elevation myocardial infarction. Primary angioplasty. Coronary bifurcation. Propensity score.

Abstract

Introduction and objectives

We assessed short- and long-term outcomes of primary angioplasty in ST-segment elevation myocardial infarction by comparing bifurcation culprit lesions (BCL) with non-BCL.

Methods

Observational study with a propensity score matched control group. Among 2746 consecutive ST-segment elevation myocardial infarction patients, we found 274 (10%) patients with BCL. The primary outcome was a composite endpoint including all-cause death, myocardial infarction, coronary artery bypass grafting or target vessel revascularization, assessed at 30-days and 5-years.

Results

Baseline characteristics showed no differences after propensity matching (1:1). In the BCL group, the most frequent strategy was provisional stenting of the main branch (84%). Compared with the non-BCL group, the procedures were technically more complex in the BCL group in terms of need for balloon dilatation (71% BCL vs 59% non-BCL; P = .003), longer procedural time (70 ± 29 minutes BCL vs 62.8 ± 28.9 minutes non-BCL; P = .004) and contrast use (256.2 ± 87.9 mL BCL vs 221.1 ± 82.3 mL non-BCL; P < .001). Main branch angiographic success was similar (93.4% BCL vs 93.8% non-BCL; P = .86). Thirty-day all-cause mortality was similar between groups: 4.7% BCL vs 5.1% non-BCL; P = .84. At the 5-year follow-up, there were no differences in all-cause death (12% BCL vs 13% non-BCL; P = .95) or the combined event (22% BCL vs 21% non-BCL; P = .43).

Conclusions

Primary angioplasty of a BCL was technically more complex; however, main branch angiographic success was similar, and there were no differences in long-term prognosis compared with non-BCL patients.

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1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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