Clinical outcomes of percutaneous coronary interventions in patients with bifurcation lesions of the left main coronary artery (results from the Multicenter Registry for the study of bifurcation intervention)

• Utegenov R.B.
• Khelimsky D.A.
• Badoyan A.G.
• Baranov A.A.
• Gorgulko A.P.
• Krestyaninov O.V.
• Bessonov I.S.
• Eraliev T.K.

Abstract

Bifurcation lesion of the coronary artery is one of the most difficult fields in interventional cardiology, accounting for 15–20% of the total number of atherosclerotic lesions of the coronary arteries.

Aim. To investigate procedural and clinical outcomes in patients undergoing PCI for left main bifurcation disease in comparison with non-left main bifurcations.

Material and methods. We retrospectively analyzed 1230 patients undergoing PCI of bifurcation lesions in coronary arteries. Patients were divided into 2 groups: with left main bifurcation disease (n=285) and non-left main bifurcation lesions (n=945).

Results. The overall prevalence of left main bifurcation lesions was 23%. Most of patients, in each of groups, were males: 704 (74.5%) and 208 (73%), respectively, and these patients more often had associated peripheral arterial lesions (10.5% vs 6.5%, p=0,028). True bifurcation lesions was statistically higher in the non-LM bifurcation group (23.3% vs 13.7%, p=0,0004). The mean Syntax Score of patients with bifurcation of the left main coronary artery was 17.7±6.7 points. Main branch predilatation was statistically lower in the LM bifurcation group (50.5% vs 74%, p<0,0001), while side branch predilatation was more common in the LM bifurcation group (23.5 vs 17.1%, p=0,015). There was no difference in the frequency of two-stents techniques between groups (12.3% versus 8.5%, p=0.06). Final kissing postdilatation was more often performed in the LM group (66 vs 34.7%, p<0,0001). Technical success in the main branch did not differ in compared groups, while technical success in the side branch was higher in LM group (92% vs 71.2%, p<0,0001). The overall in-hospital MACCE rate was 1.8% in the group of LM bifurcation lesions versus 2.1% in the non-LM bifurcations (p=0.8). However, stent deformation was statistically higher among the procedural complications in LM bifurcation group (2.1% vs 0.3%, p=0,007).

Conclusion. PCI of the LM bifurcation lesions is associated with good immediate results and a low incidence of periprocedural complications comparable to bifurcation lesions of non-LM localization.

Keywords:bifurcation lesions; coronary arteries; bifurcation stenting; left main coronary artery; percutaneous coronary intervention

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