Contemporary coronary intervention in bifurcation lesions – two-year follow-up in an unselected cohort
Dariusz Dudek, Jacek Legutko, Paweł Zymek, Grzegorz L. Kałuża, Jacek S. Dubiel
Med Sci Monit 2002; 8(9): CR647-651
Background: Optimization of coronary angioplasty in bifurcation lesions remains a major challenge for percutaneous revascularization techniques.
Material/Methods: We evaluated procedural success, major in-hospital complications, target vessel revascularization, and 2-year clinical outcomes in 45 patients who underwent PTCA of a bifurcation lesion
using currently available techniques and rigorous criteria for optimal immediate result.
Results: Angiographic success occurred in 100% of the parent vessels and in 84.4% of both vessels. Within the first 24 hours, there were no deaths or Q-wave myocardial infarction. Three non- Q-wave myocardial infarctions occurred (6.6%) and one emergency PTCA was necessary
(2.2%). Therefore, clinical success was achieved in 91.2% of these patients. At 2-year follow-up, 3 cardiac deaths had occurred, the target revascularization rate was 20%, and the total frequency of major adverse cardiac events (MACE) was 37.8%.
Conclusions: Optimization of coronary angioplasty in bifurcation lesions is possible and results in a high angiographic success rate, low risk of acute complications and acceptable long-term clinical
outcomes. However, the fairly high incidence of MACE at 2 years suggests that bifurcation lesions remain a challenge in everyday practice despite contemporary intervention methods and the use of GPIIb/IIIa inhibitors.
Keywords: Aged, Angioplasty - methods, Arteriosclerosis, Cohort Studies, Coronary Restenosis, Coronary Vessels - injuries, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Revascularization, Time Factors, Treatment Outcome