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Research Article| Volume 250, P92-97, January 01, 2018

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Percutaneous coronary intervention of bifurcation lesions and platelet reactivity

Published:October 06, 2017DOI:https://doi.org/10.1016/j.ijcard.2017.10.022
Percutaneous coronary intervention of bifurcation lesions and platelet reactivity
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      Abstract

      Background

      Although bifurcation percutaneous coronary intervention (PCI) is associated with lower procedural success rates and higher risk of complications, there are little data regarding outcomes after successful bifurcation PCI with contemporary stents and techniques. Whether residual platelet reactivity (PR) affects outcomes differently after bifurcation versus non-bifurcation PCI is also unknown. We studied the association between bifurcation PCI, PR, and clinical outcomes among patients undergoing successful PCI with drug-eluting stents.

      Methods

      Patients in the prospective, multicenter ADAPT-DES study were stratified according to whether they underwent bifurcation PCI. Two-year outcomes were compared between groups using Cox proportional hazards models. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, and ischemia-driven target vessel revascularization.

      Results

      Among the 8582 patients included in ADAPT-DES, 1276 (15%) had bifurcation PCI. Bifurcation PCI was independently associated with increased risk of TVF (adjusted hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.08–1.46, p = 0.003), driven by higher risk of myocardial infarction (5.9% vs. 4.6%, p = 0.033) and ischemia-driven target vessel revascularization (13.0% vs. 9.2%, p < 0.0001). There was no statistical interaction between PR and bifurcation PCI regarding TVF risk (adjusted pinteraction = 0.87). Stenting of both bifurcation branches was associated with the highest risk of TVF (adjusted HR 1.91, 95% CI 1.48–2.46 versus non-bifurcation PCI; ptrend < 0.001).

      Conclusions

      Bifurcation PCI is associated with a higher risk of 2-year adverse ischemic events than non-bifurcation PCI, a risk that is particularly high when both bifurcation branches are stented, and with HPR conferring similar risk for bifurcation and non-bifurcation PCI.

      Keywords

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      Article info

      Publication history

      Published online: October 06, 2017
      Accepted: October 5, 2017
      Received in revised form: May 15, 2017
      Received: March 3, 2017

      Identification

      DOI: https://doi.org/10.1016/j.ijcard.2017.10.022

      Copyright

      © 2017 Elsevier B.V. All rights reserved.

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