OUTCOMES OF PROVISIONAL STENTING WITH VERSUS WITHOUT SIDE BRANCH INTERVENTION IN PATIENTS WITH BIFURCATION LESION-RELATED ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

. NASRULLAH; AA SOLANGI; . ABEER; . SHAHZEB; MW SALEEM; . ZAHIRULLAH

doi:10.54112/bcsrj.v2024i1.1174

Authors

. NASRULLAH Department of Interventional Cardiology Peshawar Institute of Cardiology, Peshawar, Pakistan
AA SOLANGI Department of Interventional Cardiology Peshawar Institute of Cardiology, Peshawar, Pakistan
. ABEER Department of Interventional Cardiology Sindh Institute of Cardiovascular Disease, Pakistan
. SHAHZEB Department of Interventional Cardiology Peshawar Institute of Cardiology, Peshawar, Pakistan
MW SALEEM Department of Interventional Cardiology Peshawar Institute of Cardiology, Peshawar, Pakistan
. ZAHIRULLAH Department of Pulmonology District Headquarters Hospital Charsadda, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1174

Keywords:

Coronary Artery Disease, Myocardial Infarction, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction, Stents

Abstract

Bifurcation lesions in patients with ST-segment elevation myocardial infarction (STEMI) present a unique challenge in interventional cardiology. The need for side-branch intervention during provisional stenting in such cases remains a subject of debate. Objective: This study aimed to provide robust evidence on the necessity of side-branch intervention during provisional stenting in patients with STEMI and bifurcation lesions. Methods: This observational study was conducted at the Peshawar Institute of Cardiology from August 2023 to August 2024. A total of 248 patients diagnosed with STEMI and bifurcation lesions were included. The patients were divided into two groups: those who underwent side-branch intervention (n = 112) and those managed without side-branch intervention (n = 136). Baseline characteristics such as age, gender, hypertension, diabetes, smoking history, body mass index (BMI), prior myocardial infarction (MI), and previous percutaneous coronary intervention (PCI) were compared between the groups. Statistical analysis was performed to identify significant differences. Results: The baseline characteristics of the two groups were similar, with no statistically significant differences. The average age was 58.7 ± 10.9 years in the side-branch intervention group and 58.3 ± 11.4 years in the no-intervention group. The male proportion was also comparable between the two groups (69% vs. 71%). Both groups had an equal prevalence of hypertension (62%) and similar rates of diabetes (29% vs. 28%) and smoking history (36% vs. 34%). Other factors such as BMI, previous MI, and previous PCI showed no significant differences. Conclusion: This study concludes that provisional stenting without routine side-branch intervention is a safe and effective strategy for managing bifurcation lesion-related STEMI. Given the comparable outcomes between the two groups, routine side-branch intervention may not be necessary, thus simplifying the treatment approach and reducing procedural complexities.

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References

Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749-67.

Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, et al. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation. 2006;114(18):1955-61.

Chen S-L, Sheiban I, Xu B, Jepson N, Paiboon C, Zhang J-J, et al. Impact of the complexity of bifurcation lesions treated with drug-eluting stents: the DEFINITION study (Definitions and impact of complEx biFurcation lesIons on clinical outcomes after percutaNeous coronary IntervenTIOn using drug-eluting steNts). JACC: Cardiovascular Interventions. 2014;7(11):1266-76.

Zhang J-J, Ye F, Xu K, Kan J, Tao L, Santoso T, et al. Multicentre, randomized comparison of two-stent and provisional stenting techniques in patients with complex coronary bifurcation lesions: the DEFINITION II trial. European Heart Journal. 2020;41(27):2523-36.

Colombo A, Bramucci E, Saccà S, Violini R, Lettieri C, Zanini R, et al. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study. Circulation. 2009;119(1):71-8.

Hildick-Smith D, de Belder AJ, Cooter N, Curzen NP, Clayton TC, Oldroyd KG, et al. Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation. 2010;121(10):1235-43.

Hildick-Smith D, Egred M, Banning A, Brunel P, Ferenc M, Hovasse T, et al. The European bifurcation club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN). European Heart Journal. 2021;42(37):3829-39.

Di Gioia G, Sonck J, Ferenc M, Chen S-L, Colaiori I, Gallinoro E, et al. Clinical outcomes following coronary bifurcation PCI techniques: a systematic review and network meta-analysis comprising 5,711 patients. Cardiovascular Interventions. 2020;13(12):1432-44.

Chen X, Li X, Zhang J-J, Han Y, Kan J, Chen L, et al. 3-year outcomes of the DKCRUSH-V trial comparing DK crush with provisional stenting for left main bifurcation lesions. JACC: Cardiovascular Interventions. 2019;12(19):1927-37.

Chen S-L, Santoso T, Zhang J-J, Ye F, Xu Y-W, Fu Q, et al. A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DKCRUSH-II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) trial. Journal of the American College of Cardiology. 2011;57(8):914-20.

Chen S-L, Ye F, Zhang J-J, Xu T, Tian N-L, Liu Z-Z, et al. Randomized comparison of FFR-guided and angiography-guided provisional stenting of true coronary bifurcation lesions: the DKCRUSH-VI trial (Double Kissing Crush Versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions VI). JACC: Cardiovascular Interventions. 2015;8(4):536-46.

Sheiban I, Ge Z, Kan J, Nie S, Zhang JJ, Santoso T, et al. Association of peri‐procedural myocardial infarction with mortality after stenting true coronary bifurcation lesions: A pooled individual participant data analysis from four randomized controlled trials. Catheterization and Cardiovascular Interventions. 2022;99(3):617-26.

Mauri L, Hsieh W-h, Massaro JM, Ho KK, D'Agostino R, Cutlip DE. Stent thrombosis in randomized clinical trials of drug-eluting stents. New England journal of medicine. 2007;356(10):1020-9.

Vassilev D, Mileva N, Collet C, Nikolov P, Sokolova K, Karamfiloff K, et al. Bifurcation functional significance score as predictor of mortality: a validating study. Scientific Reports. 2021;11(1):24308.

Song YB, Hahn J-Y, Song P-S, Yang JH, Choi J-H, Choi S-H, et al. Randomized Comparison of Conservative Versus Aggressive Strategy for Provisional Side Branch Intervention in Coronary Bifurcation Lesions: Results From the SMART-STRATEGY (SMart Angioplasty Research Team–Optimal STRATEGY for Side Branch Intervention in Coronary Bifurcation Lesions) Randomized Trial. JACC: Cardiovascular Interventions. 2012;5(11):1133-40.

Song YB, Park TK, Hahn J-Y, Yang JH, Choi J-H, Choi S-H, et al. Optimal strategy for provisional side branch intervention in coronary bifurcation lesions: 3-year outcomes of the SMART-STRATEGY randomized trial. JACC: Cardiovascular Interventions. 2016;9(6):517-26.